Int Urol Nephrol [JOURNAL]
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200 papers
Magnetic resonance urethrography-derived geometric parameters and their association with surgical complexity in pelvic fracture urethral injury repair.
Bhusal I, Jain S, Gupta M … +6 more , Chandola S, Sharma S, Seth A, Nayyar R, Kumar M, Kumar S
Int Urol Nephrol · 2026 Apr · PMID 42026397 · Publisher ↗
BACKGROUND: Accurate preoperative planning is vital for successful surgical repair of pelvic fracture urethral injuries (PFUI). Magnetic resonance urethrography (MRU) offers a more detailed anatomical assessment of the p...
BACKGROUND: Accurate preoperative planning is vital for successful surgical repair of pelvic fracture urethral injuries (PFUI). Magnetic resonance urethrography (MRU) offers a more detailed anatomical assessment of the posterior urethra than conventional urethrography. This study evaluates the role of MRU in PFUI repairs. METHODS: This was a prospective, single-center observational study conducted at a tertiary academic institution between August 2022 and December 2024, aimed at correlating the surgical complexity of PFUI repairs with preoperative geometric parameters derived from MRU and conventional urethrography. Male patients aged ≥ 18 years diagnosed with PFUI were included. RESULTS: Twenty male patients were studied, with a median age of 26 years (IQR: 20.5-36). The bulbomembranous urethra was the most frequent site of disruption (80%). Mean urethral gap measured 2.68 cm (SD 1.13) on MRU and 3.09 cm (SD 1.19) on conventional urethrography. Thirteen patients (65%) underwent non-pubectomy urethroplasty (NPU), and 7 underwent urethroplasty with pubectomy (PU). Within the NPU group, urethral mobilization sufficed in five, while eight required additional corporal separation. On MRU, mean distraction defect was significantly greater in the PU group (3.55 vs 2.22 cm in the NPU group, p < 0.01). Both MRU and conventional urethrography performed well on concordance analysis against the true gap length, with concordance correlation coefficients of 0.969 and 0.894 respectively. CONCLUSION: Magnetic resonance urethrography (MRU) provides a more comprehensive and precise preoperative evaluation of PFUI compared to conventional urethrography, offering better visualization of the prostatic urethra, accurate gap measurement along with assessment of periurethral anatomic relationships.
Clinical significance of the combined systematic 12-core with concomitant MRI image-guided targeted prostate biopsy: can the MRI targeted biopsy stand on its own?
Seabury CA, Shakroo YM, Ramnani DM … +2 more , Qian J, Seabury CA
Int Urol Nephrol · 2026 Apr · PMID 42020630 · Publisher ↗
PURPOSE: To determine whether magnetic resonance imaging (MRI) image-guided biopsy (Targeted Bx) is accurate enough to replace the Combined Targeted Bx and systematic template 12-core transrectal ultrasound-guided prosta...
PURPOSE: To determine whether magnetic resonance imaging (MRI) image-guided biopsy (Targeted Bx) is accurate enough to replace the Combined Targeted Bx and systematic template 12-core transrectal ultrasound-guided prostate biopsy (Systematic Bx) in the detection of clinically significant prostate cancer (csPCA, Gleason score > 6), and if Targeted Bx alone significantly outperforms Systematic Bx. MATERIALS AND METHODS: Data were collected retrospectively from all patients with MRI Prostate Image Reporting and Data System (PIRADS) level 3 and above that received a Combined Targeted Bx and Systematic Bx from 11/1/22 to 6/8/23 at Virginia Urology, a large community urology group. Patient information was entered into a database and analyzed using Chi-square and t-test. RESULTS: A total of 474 patients were identified. MRI results showed that 152 (32.1%) cases were PIRADS 3, 218 (46.0%) cases were PIRADS 4, and 104 (21.9%) cases were PIRADS 5. Overall, the combined targeted and systematic biopsy (Combined Bx) detected more clinically significant PCA (294, 62.0%) than the Systematic Bx (231, 48.7%) or Targeted Bx (237, 50.0%) did alone. Isolation of PIRADS 5 alone showed clinical insignificance in the combined biopsy versus the targeted biopsy alone. The systematic and targeted methods are insignificantly different from each other (P > 0.05), across all PIRADS levels. CONCLUSIONS: Combined systematic and targeted biopsy was significantly better in the diagnosis of csPCA across PIRADS 3 to 5. For patients with PIRADS 5, combined biopsies were not significantly different from targeted biopsies. We determined that we could not remove the systematic biopsy from our current technique. Additionally, systematic biopsies still perform well in the detection of csPCA.
Perioperative complications in native nephrectomy as a therapeutic approach for symptomatic polycystic kidney disease: a comprehensive study.
Helal Birjandi A, Richter N, Faraj Tabrizi P … +3 more , Idais H, Kuczyk MA, Tezval H
Int Urol Nephrol · 2026 Apr · PMID 42012776 · Publisher ↗
PURPOSE: To assess perioperative complications after native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD), identify risk factors and evaluate surgical timing and approach. METHODS: We retrospectivel...
PURPOSE: To assess perioperative complications after native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD), identify risk factors and evaluate surgical timing and approach. METHODS: We retrospectively analyzed 124 nephrectomy episodes in patients with ADPKD treated at a single tertiary center between October 2012 and October 2022. Complications were graded according to the Clavien-Dindo classification. Multivariable logistic regression was used to assess predictors of overall and major complications. RESULTS: Perioperative complications occurred in 73/124 episodes (58.9%), including 31 major complications (25.0%). Lower preoperative hemoglobin independently predicted overall complications (OR 0.74 per g/dL, 95% CI 0.61-0.89; p = 0.002), whereas left-sided nephrectomy was associated with a lower overall complication risk (OR 0.25, 95% CI 0.09-0.72; p = 0.011). Diverticulosis independently predicted major complications (OR 5.03, 95% CI 1.76-14.33; p = 0.003). Simultaneous bilateral nephrectomy showed the highest overall complication rate (69.7%). Open procedures were performed for markedly larger kidneys than minimally invasive procedures (median operative specimen weight 3518.5 g vs 495.5 g; p < 0.001). Minimally invasive surgery was not independently associated with a lower complication risk (OR 0.75, 95% CI 0.15-3.79; p = 0.726). CONCLUSION: Native nephrectomy in ADPKD is associated with substantial perioperative morbidity and should remain restricted to carefully selected patients. Surgical timing relative to transplantation should be guided primarily by symptoms and clinical necessity. Simultaneous bilateral nephrectomy appears to carry the greatest perioperative burden. Although minimally invasive surgery is feasible in selected patients with smaller kidneys, our data do not demonstrate an independent reduction in morbidity after adjustment for case complexity.
External validation of the Meet-URO score in Japanese metastatic renal cell carcinoma patients receiving first-line immune-combinations.
Yajima S, Yoshida S, Fukuda S … +16 more , Chen W, Sato H, Hirakawa A, Fukushima H, Matsuoka Y, Kageyama Y, Tanaka H, Inoue M, Numao N, Yonese J, Nakayama A, Saito K, Ito M, Koga F, Masuda H, Fujii Y
Int Urol Nephrol · 2026 Apr · PMID 42012775 · Publisher ↗
PURPOSE: The Meet-URO score, incorporating IMDC classification, neutrophil-to-lymphocyte ratio (NLR), and bone metastases, was developed in European patients receiving second-line nivolumab; its applicability to Asian po...
PURPOSE: The Meet-URO score, incorporating IMDC classification, neutrophil-to-lymphocyte ratio (NLR), and bone metastases, was developed in European patients receiving second-line nivolumab; its applicability to Asian populations, particularly in real-world first-line immune checkpoint inhibitor (ICI)-based combination cohorts, remains uncertain. We externally validated the Meet-URO score in Japanese patients with metastatic renal cell carcinoma (mRCC) receiving first-line ICI-based combinations. METHODS: This retrospective multicenter study enrolled mRCC patients treated with first-line ICI-based combinations at five Japanese institutions, stratified into five Meet-URO groups; overall survival (OS) was the primary endpoint, evaluated using Harrell's C-index. RESULTS: Between 2018 and 2022, 152 patients were screened and 151 patients were enrolled. Treatment regimens included nivolumab plus ipilimumab (64.9%), pembrolizumab plus axitinib (27.8%), avelumab plus axitinib (4.0%), and nivolumab plus cabozantinib (3.3%). The median potential follow-up was 16.1 months (95%CI 13.2-19.3), estimated by the reverse Kaplan-Meier method. The Meet-URO score significantly stratified OS (p = 0.0017), cancer-specific survival (p = 0.0022), and progression-free survival (p = 0.0428). The 24-month OS rates were 100%, 94.8%, 55.0%, 54.9%, and 39.7% for Groups 1-5, respectively. The C-index for OS was 0.731 (95%CI 0.655-0.807), numerically higher than but not statistically significantly different from IMDC classification (0.702; bootstrap difference 0.029, 95%CI - 0.082 to 0.134, p = 0.298). Overall response rate and disease control rate differed significantly across groups, whereas grade ≥ 3 adverse events did not. CONCLUSION: This study provides an Asian validation of the Meet-URO score, supporting its prognostic utility in this Japanese multicenter cohort receiving first-line ICI-based combinations. Treatment imbalance across Meet-URO groups and a short follow-up warrant cautious interpretation and further validation.
Early versus deferred immunotherapy in urothelial carcinoma: a review of evidence and post-progression survival.
Petrelli F, Ghidini A, Vavassori I … +3 more , Rossitto M, D'Alessio A, Dottorini L
Int Urol Nephrol · 2026 Apr · PMID 42012774 · Publisher ↗
OBJECTIVE: Metastatic urothelial carcinoma has undergone a major therapeutic transition, with first-line immune checkpoint inhibitor-based combinations now established as standard care. In this context, the key clinical...
OBJECTIVE: Metastatic urothelial carcinoma has undergone a major therapeutic transition, with first-line immune checkpoint inhibitor-based combinations now established as standard care. In this context, the key clinical question is no longer whether early immunotherapy should be used, but how evidence from historical deferred approaches, switch-maintenance, and contemporary upfront regimens can be interpreted through the lens of post-progression survival (PPS), a major determinant of overall survival (OS). METHODS: A narrative synthesis of randomized phase II-III trials (2016-2025), PubMed-indexed studies, and real-world datasets was performed. Data on efficacy (OS, progression-free survival [PFS], PPS), safety, and rates of access to second-line therapy were extracted from JAVELIN Bladder 100, KEYNOTE-045, EV-302/KEYNOTE-A39, CheckMate-901, KEYNOTE-361, IMvigor130, and DANUBE. RESULTS: Avelumab maintenance improved OS (23.8 vs 15.0 months) despite >50% crossover to ICIs. Pembrolizumab after progression prolonged OS (10.3 vs 7.4 months) without PFS benefit, highlighting PPS as a major survival determinant. Real-world evidence indicates that only a minority of patients initiating first-line therapy ultimately receive second-line treatment, supporting therapeutic strategies that ensure earlier exposure to immunotherapy. Frontline combinations, such as enfortumab vedotin plus pembrolizumab and nivolumab plus cisplatin/gemcitabine, have, therefore, redefined the treatment paradigm and are now preferred standards or validated frontline options, whereas pembrolizumab-chemotherapy, atezolizumab-based combinations, and dual-checkpoint approaches have not demonstrated comparable survival benefit. CONCLUSIONS: Early integration of immunotherapy remains the key principle underlying survival improvement in metastatic urothelial carcinoma, but this concept must now be interpreted within a modern therapeutic framework in which enfortumab vedotin plus pembrolizumab is the preferred first-line regimen for most patients. Avelumab maintenance and post-platinum pembrolizumab remain historically pivotal benchmark strategies and may still retain relevance where newer regimens are unavailable or unsuitable. Across treatment eras, PPS appears to be a major driver of OS and deserves more systematic reporting in future trials.
Prostate abscess in tropical northern Australia: drainage strategies and outcomes.
Peacey J, Tan C, Afolabi O … +2 more , Wilkins J, Pridgeon S
Int Urol Nephrol · 2026 Apr · PMID 42012773 · Publisher ↗
PURPOSE: Prostate abscess is an uncommon but potentially life-threatening condition. In tropical Australia, melioidosis caused by Burkholderia pseudomallei represents a unique and under-recognized etiology. We aimed to e...
PURPOSE: Prostate abscess is an uncommon but potentially life-threatening condition. In tropical Australia, melioidosis caused by Burkholderia pseudomallei represents a unique and under-recognized etiology. We aimed to evaluate drainage strategies and clinical outcomes of prostate abscess in a tropical referral center. METHODS: A retrospective cohort study was conducted of all patients undergoing procedural drainage for radiologically confirmed prostate abscess at Cairns Hospital between August 2016 and October 2025. Demographic, clinical, microbiological, radiologic, and operative data were collected. Patients were stratified into melioid and non-melioid cohorts. Outcomes were analyzed descriptively by drainage modality and microbiological profile. RESULTS: 84 drainage procedures were performed. The mean age was 60 years (range 17-95). Burkholderia pseudomallei accounted for 50% of cases. Transurethral deroofing (TUD) was the most common drainage modality (n = 69; 82%), followed by transrectal ultrasound-guided aspiration (n = 9), transperineal aspiration (n = 3), and transrectal incision and drainage (n = 3). Secondary intervention was required in 33% of patients undergoing primary aspiration compared with 1% following TUD. ICU admission occurred in 19 patients overall and was more frequent in those with melioid disease. Long-term urinary and sexual symptoms were more frequently documented following TUD, although interpretation is limited by the retrospective design and lack of validated outcome measures. CONCLUSION: Prostate abscess in tropical northern Australia is strongly associated with melioidosis and systemic infection. Transurethral deroofing is commonly utilized for multifocal and complex disease, while minimally invasive approaches may be appropriate in selected cases. Observed differences in outcomes likely reflect disease severity and selection bias. Early recognition and tailored drainage strategies are essential to optimize outcomes.
Clinical insights on "Effect of large language model on diagnostic accuracy and clinical completeness among nephrology fellows managing transplant infection".
Jabeen D
Int Urol Nephrol · 2026 Apr · PMID 42010050 · Publisher ↗
Abstract loading — click title to view on PubMed.
Kidney transplant outcomes in patients aged ≥ 70 years: a systematic review and meta-analysis of multicenter or registry-based studies with future directions and a multicenter study proposal.
Prevezanos D, Kossenas K, Vernadakis S … +3 more , Kykalos S, Nikiteas N, Dimitroulis D
Int Urol Nephrol · 2026 Apr · PMID 42001369 · Publisher ↗
BACKGROUND: Kidney transplantation in recipients aged ≥ 70 years is increasing, yet outcome data remain heterogeneous, with current evidence being limited to pooled results from single and multicenter studies. This study...
BACKGROUND: Kidney transplantation in recipients aged ≥ 70 years is increasing, yet outcome data remain heterogeneous, with current evidence being limited to pooled results from single and multicenter studies. This study aims to investigate the impact of advanced age on patient survival as well as graft-related outcomes from multicenter and registry-based studies and to propose a multicenter study to bridge any identified research gap. METHODS: The PRISMA and the Cochrane Handbook were followed. This review included multicenter studies and registry-based comparative studies only, which are less prone to selection bias. Outcomes were analysed using risk ratios (RRs) at fixed time points, when applicable, with a random-effects Mantel-Haenszel model. RESULTS: Five multicenter studies including a total of 272,982 recipients, of whom 16,309 were aged ≥ 70 years, were included. Recipients aged ≥ 70 years had a lower overall and 5-year survival, RR = 0.87 (95% CI 0.77-0.99; p = 0.04, I = 96%, τ = 0.00) and RR = 0.86 (95% CI 0.81-0.92; p = 0.02, I = 0%, τ = 0.00), respectively, compared to < 70. No significant differences were observed for 1- and 3-year patient survival between the two age groups. Moreover, no significant differences were observed for overall graft survival, 1-, 3-, or 5-year graft survival, delayed graft function, acute rejection and graft loss between the two age groups. Substantial heterogeneity was observed for long-term outcomes. CONCLUSION: Kidney transplantation in carefully selected recipients aged ≥ 70 years is associated with preserved graft survival and comparable early graft-related outcomes, but lower overall and 5-year survival, compared to those < 70 years of age. However, due to the limited number of studies included and substantial heterogeneity, future large multicenter studies including geriatric variables are required to determine the role of age on patient survival and graft-related outcomes. TRIAL REGISTRATION: PROSPERO: CRD420261293247.
Oncologic outcomes and prognostic significance of lymphovascular invasion in renal cell carcinoma according to nodal stage.
Kang BJ, Song WH
Int Urol Nephrol · 2026 Apr · PMID 42000936 · Publisher ↗
PURPOSE: To assess the prognostic significance of lymphovascular invasion (LVI) in patients with renal cell carcinoma (RCC), stratified by nodal status (N0 vs. N1), and to evaluate its influence on survival and periopera...
PURPOSE: To assess the prognostic significance of lymphovascular invasion (LVI) in patients with renal cell carcinoma (RCC), stratified by nodal status (N0 vs. N1), and to evaluate its influence on survival and perioperative outcomes. MATERIALS AND METHODS: A retrospective review was conducted of 2787 patients with clinical T1-2 RCC who underwent nephrectomy at a single tertiary center. Patients were categorized by LVI status and pathologic nodal stage (N0 or N1). Clinicopathological features, perioperative outcomes, and oncologic endpoints-including recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS)-were analyzed using Kaplan-Meier analysis and Cox proportional hazards models. RESULTS: Among N0 patients, LVI-positive tumors were associated with adverse preoperative markers, higher Fuhrman grades, larger tumor sizes, and poorer perioperative outcomes. These associations were not observed in N1 patients. Kaplan-Meier analysis demonstrated significantly lower RFS, DSS, and OS among patients with LVI in the N0 group (all p < 0.001), but not in the N1 group. In multivariable analysis for N0 patients, LVI remained an independent predictor of OS (hazard ratio 1.804, 95% confidence interval 1.107-2.939, p = 0.018). CONCLUSIONS: LVI is a significant prognostic factor for recurrence and survival in node-negative RCC, but not in node-positive disease. These results support a stage-dependent interpretation of LVI and its incorporation into postoperative surveillance and individualized risk stratification for patients with low-stage RCC.
Ferroptosis and interstitial cystitis: a systematic review of preclinical evidence and molecular mechanisms.
Grigoryan B, Kasyan V, Baboudjian M … +2 more , Plekhanova O, Pushkar D
Int Urol Nephrol · 2026 Apr · PMID 41999537 · Publisher ↗
BACKGROUND: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic inflammatory bladder disorder with a poorly understood etiology and limited therapeutic options. Ferroptosis, an iron-dependent form of regula...
BACKGROUND: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic inflammatory bladder disorder with a poorly understood etiology and limited therapeutic options. Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has recently been implicated in bladder epithelial damage, suggesting a potential role in IC/BPS pathogenesis. OBJECTIVE: To systematically review available preclinical studies examining the potential role of ferroptosis in experimental models relevant to interstitial cystitis, with a focus on molecular mechanisms and ferroptosis-related biomarkers. METHODS: This systematic review was conducted in accordance with the PRISMA 2020 guidelines. A structured PICO framework was used to identify eligible preclinical studies that evaluated ferroptosis in animal models or ex vivo systems mimicking interstitial cystitis. Data were extracted regarding ferroptosis markers, signaling pathways, and therapeutic interventions. RESULTS: Four preclinical studies were included, involving rodent models of cyclophosphamide- and LPS-induced cystitis, cystitis glandularis, and one study incorporating human bladder biopsies. Across all studies, ferroptosis was consistently associated with bladder injury, characterized by decreased expression of GPX4 and SLC7A11, elevated malondialdehyde (MDA), and increased lipid ROS. Key regulatory pathways involved included Wnt/β-catenin, NF-κB, and Nrf2. Ferroptosis inhibitors such as dexrazoxane, hydrogen sulfide donors, dietary restriction, and pachymic acid attenuated bladder damage by restoring redox homeostasis. None of the studies evaluated pain-related outcomes or functional bladder parameters, which limits the translational interpretation of findings in the context of IC/BPS symptomatology. CONCLUSIONS: This systematic review highlights ferroptosis as a compelling mechanistic link between chronic inflammation and urothelial injury in interstitial cystitis/bladder pain syndrome. Targeting ferroptosis may offer a novel disease-modifying strategy in a condition where current treatments remain largely symptomatic. Future translation into clinical settings could involve biomarker-guided phenotyping and intravesical delivery of ferroptosis-modulating agents to achieve localized and pathogenesis-based therapy. However, given the limited number of studies and the lack of human validation, these findings should be considered preliminary and hypothesis-generating.
Exploratory research on efficacy and safety of a fine-needle tibial nerve stimulator for treating overactive bladder in cats.
Jin L, Shang D, Deng H … +6 more , Li C, Wang Z, Li H, Liao L, Guo Y, Li X
Int Urol Nephrol · 2026 Apr · PMID 41999536 · Publisher ↗
PURPOSE: To explore the efficacy and safety of a novel fine-needle percutaneous tibial nerve stimulator for the treatment of overactive bladder (OAB) in cats. METHODS: The stimulator was placed on the medial malleolus of...
PURPOSE: To explore the efficacy and safety of a novel fine-needle percutaneous tibial nerve stimulator for the treatment of overactive bladder (OAB) in cats. METHODS: The stimulator was placed on the medial malleolus of cats (n = 8, three females and five males). Stimulation was controlled through a mobile application. Serial cystometrograms (CMGs) were conducted by infusing either 0.25% acetic acid (AA) or 0.9% normal saline (NS) to evaluate the effects of percutaneous tibial nerve stimulation (PTNS) on the micturition reflex. Histologic analysis of the tibial nerve and surrounding muscle tissue was conducted to determine its safety. RESULTS: During NS infusion, PTNS at 2 T significantly increased bladder capacity (BC) to 144.20 ± 5.85% compared with the NS control level (10.40 ± 3.19 ml) (P < 0.001). During AA infusion, AA-induced OAB significantly reduced BC to 56.64 ± 1.55% compared with the control level (P < 0.001). PTNS at 2 T significantly increased BC to 76.39 ± 5.47% compared with the AA level (P < 0.001). Furthermore, AA significantly reduced the contraction duration compared to the NS control level (4.39 ± 2.08 min) (P < 0.001). PTNS significantly increased the contraction duration compared to the AA group (P < 0.05). However, the contraction amplitude and area under the curve showed no significant differences among the NS control, AA, and PTNS groups (P > 0.05). Histologic analysis revealed no discernible abnormalities or structural damage to nerve fibers or adjacent musculature. CONCLUSIONS: The novel PTNS device could inhibit OAB in cats and may offer a promising and minimally invasive treatment for OAB.
Correction: Factors affecting the need for ureteral catheterization in symptomatic pregnancy hydronephrosis.
Gercek O, Topal K, Yazar VM … +1 more , Demirbas A
Int Urol Nephrol · 2026 Apr · PMID 41995988 · Publisher ↗
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Clinical characteristics and kidney outcomes in children with posterior urethral valve: a single-center experience.
Inceoğlu S, Uçkardeş D, Göknar N
Int Urol Nephrol · 2026 Apr · PMID 41995987 · Publisher ↗
INTRODUCTION AND AIM: Posterior urethral valve (PUV) represent a congenital obstructive uropathy, and despite advances in prenatal diagnosis and postnatal management, chronic kidney disease (CKD) develops in nearly 20% o...
INTRODUCTION AND AIM: Posterior urethral valve (PUV) represent a congenital obstructive uropathy, and despite advances in prenatal diagnosis and postnatal management, chronic kidney disease (CKD) develops in nearly 20% of affected patients. The aim of this study is to determine the clinical characteristics and kidney outcomes in children with PUV. MATERIALS AND METHODS: A total of 52 boys followed with a diagnosis of posterior urethral valves were retrospectively evaluated. Data regarding antenatal diagnosis, age at admission, and timing of cystoscopic diagnosis were recorded. Clinical and laboratory data, including serum creatinine levels and glomerular filtration rate, ultrasonographic findings, urodynamic study results, DMSA findings, and voiding cystourethrography results, were collected. In addition, lower urinary tract symptoms and the frequency of lower urinary tract infections were documented. FINDINGS: The mean age of the 52 patients was 9.8 ± 4.8 years, and the mean age at diagnosis was 28 ± 41 months. Antenatal diagnosis was present in 32 patients (64%) and CKD developed in 10 patients (19.2%). There was no significant difference in antenatal diagnosis rates between patients with and without CKD. In the non-CKD group, hydronephrosis grades decreased significantly at the last follow-up compared with baseline, whereas no significant improvement was observed in the CKD group. These patients had more severe and persistent hydronephrosis at final evaluation. Patients with CKD had higher ratios of increased bladder wall thickness and renal echogenicity at baseline and ureteral dilatation at final follow-up. In the baseline renal function model, baseline GFR was independently associated with CKD, but proteinuria did not retain statistical significance in multivariable analysis. There was no significant difference between groups regarding severe bladder dysfunction, DMSA renal scarring, vesicoureteral reflux grades, recurrent urinary tract infections, or incontinence. CONCLUSION: Our findings suggest that renal damage in children with PUV may begin during the antenatal period. In this cohort, postnatal factors such as bladder dysfunction, vesicoureteral reflux, and recurrent urinary tract infections were not significantly associated with CKD. Persistent hydronephrosis at last follow-up was more commonly observed in children with CKD. In multivariable analysis, baseline renal function was significantly associated with CKD development.
The genitourinary phenotype of COVID: a personal perspective.
Chancellor MB
Int Urol Nephrol · 2026 Apr · PMID 41995986 · Publisher ↗
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Organ-sparing radiotherapy in penile cancer: therapeutic approaches.
Muresan A, Suciu MD, Schitcu VH … +4 more , Ona V, Varga NI, Muresan CM, Kacso G
Int Urol Nephrol · 2026 Apr · PMID 41991714 · Publisher ↗
BACKGROUND/OBJECTIVE: The primary treatment for penile squamous cell carcinoma (PSCC) is often partial or total penectomy, which causes significant functional morbidity and psychological distress. Brachytherapy (BT) has...
BACKGROUND/OBJECTIVE: The primary treatment for penile squamous cell carcinoma (PSCC) is often partial or total penectomy, which causes significant functional morbidity and psychological distress. Brachytherapy (BT) has emerged as a primary, organ-preserving alternative. The objective of this systematic review was to analyze the oncologic efficacy, organ preservation rates, and functional outcomes of LDR, PDR, and HDR brachytherapy. METHODS: This systematic review (PROSPERO: CRD420251136499) followed PRISMA guidelines. We searched PubMed, Scopus, ScienceDirect, and Google Scholar (to August 2025) for studies (n ≥ 10) reporting clinical outcomes of LDR, PDR, or HDR brachytherapy for adult penile cancer. Risk of bias was assessed using NIH tools and the Cochrane RoB tool. Due to high heterogeneity in study design and treatment techniques, a quantitative synthesis (narrative) was performed. RESULTS: Eighteen studies were included. Five-year cancer-specific survival (CSS) ranged from 85.0 to 100% across 9 studies that explicitly reported this metric. Local failures, when they occurred, were demonstrated to be highly salvageable (77-100% success). CONCLUSIONS: The evidence, though limited and highly heterogeneous, confirms that penile brachytherapy is an effective, curative-intent, organ-sparing treatment for T1-T2 disease.
Racial/ethnic differences in time to nephrectomy and its association with cancer-specific mortality in localized renal cell carcinoma.
Filzmayer M, Polverino F, Petix M … +14 more , Quarta L, Orlandi F, Goyal JA, Longo N, Musi G, Briganti A, Micali S, Shariat SF, Kosiba M, Humke C, Wenzel M, Saad F, Chun FK, Karakiewicz PI
Int Urol Nephrol · 2026 Apr · PMID 41991713 · Publisher ↗
PURPOSE: Whether racial/ethnic differences exist in time to nephrectomy (TTN) and whether prolonged TTN differentially affects cancer-specific mortality (CSM) remains unclear. We evaluated race/ethnicity as a predictor o...
PURPOSE: Whether racial/ethnic differences exist in time to nephrectomy (TTN) and whether prolonged TTN differentially affects cancer-specific mortality (CSM) remains unclear. We evaluated race/ethnicity as a predictor of prolonged TTN and assessed race/ethnicity-specific associations between TTN and CSM in localized renal cell carcinoma (RCC). METHODS: Patients were identified within the Surveillance, Epidemiology and End Results database (2010-2021) and stratified according to race/ethnicity and TTN ≤ 3 vs. > 3 months. Multivariable logistic regression models, propensity score matching (PSM) and multivariable competing risks regression models were used. RESULTS: In 11,058 T1b-2 N0 M0 clear-cell RCC patients, TTN > 3 months was recorded in 1168 (15.6%) of 7506 Caucasians, in 505 (23.6%) of 2138 Hispanics, in 180 (26.6%) of 676 African Americans, and in 118 (16.0%) of 738 Asians and Pacific Islanders (API). Hispanic (OR 1.80, p < 0.001) and African American (OR 2.10, p < 0.001) race/ethnicity independently predicted higher proportions of TTN > 3 months, compared to Caucasian. Over the study span, the proportion of patients with TTN > 3 months increased significantly in all four racial/ethnic groups (all p < 0.01). After PSM, TTN > 3 months was associated with higher CSM in Caucasians (sHR 1.57, p < 0.001) and in Hispanics (sHR 1.55, p = 0.046), but not in African Americans or APIs. CONCLUSION: In localized RCC patients treated with nephrectomy, TTN > 3 months became more prevalent over time in all four examined racial/ethnic groups. In Hispanics and African Americans, TTN > 3 months proportions were higher than in Caucasians and APIs. TTN > 3 months was independently associated with higher CSM in Caucasians and Hispanics, but not in African Americans and APIs.
Rapid bedside microscopic leukocyte counting for the diagnosis of peritoneal dialysis-associated peritonitis: diagnostic accuracy compared with automated flow cytometry.
Nardelli L, Scalamogna A, Garigali G … +6 more , Sikharulidze A, Abinti M, Hida A, Moscardino S, Alberici F, Castellano G
Int Urol Nephrol · 2026 Apr · PMID 41986777 · Publisher ↗
BACKGROUND: Peritoneal dialysis (PD)-related peritonitis remains a major cause of technique failure, morbidity, and mortality. Timely diagnosis is crucial, yet conventional white blood cell (WBC) quantification by flow c...
BACKGROUND: Peritoneal dialysis (PD)-related peritonitis remains a major cause of technique failure, morbidity, and mortality. Timely diagnosis is crucial, yet conventional white blood cell (WBC) quantification by flow cytometry (FCC) requires centralized laboratory processing, delaying treatment. This study aimed to validate a direct manual microscopic (DMC) method for bedside quantification of WBCs in peritoneal effluent as a rapid diagnostic alternative. METHODS: In this single-center study, 40 PD patients underwent 250 paired WBC assessments between January 2024 and June 2025. Peritoneal effluent samples were analyzed by both DMC and FCC at peritonitis onset, during treatment follow-up, and in asymptomatic controls. Diagnostic performance was evaluated using Spearman's correlation, receiver operating characteristic analysis, and the Youden index, employing FCC as the reference standard (> 100 cells/μL). RESULTS: Across all evaluations, DMC and FCC showed a strong correlation (ρ = 0.91, p < 0.0001). In patients evaluated for suspected peritonitis (n = 36), DMC achieved a sensitivity of 97.0% and specificity of 100% at a cut-off of 20 cells/20 HPFs (AUC = 0.99; 95% CI 0.98-1.00). During follow-up (n = 187), correlation remained high (ρ = 0.89, p < 0.0001), with sensitivity 97.2% and specificity 83.4% at 12 cells/20 HPFs (AUC = 0.97; 95% CI 0.95-0.99). CONCLUSION: DMC provides a reliable, rapid, and quantitative alternative to automated cytometry for diagnosing and monitoring PD-related peritonitis. Its simplicity, affordability, and bedside applicability make it particularly suitable for integration with home turbidity monitoring systems to improve timely peritonitis management.
Reanalysis of LUNAR progression-free survival using reconstructed individual patient data: time-varying treatment effects.
Tanabe K, Yoshida S, Fujiwara M … +9 more , Chen W, Yajima S, Sato H, Hirakawa A, Fukushima H, Yasuda Y, Tanaka H, Masuda H, Fujii Y
Int Urol Nephrol · 2026 Apr · PMID 41986776 · Publisher ↗
PURPOSE: To assess whether treatment effects in the LUNAR trial are time-varying and to contextualize a single hazard ratio (HR) using complementary, clinically interpretable summaries of when and for how long separation...
PURPOSE: To assess whether treatment effects in the LUNAR trial are time-varying and to contextualize a single hazard ratio (HR) using complementary, clinically interpretable summaries of when and for how long separation is supported by available information, in a secondary methodological reassessment. METHODS: Individual patient data were reconstructed by digitalizing published progression-free survival (PFS) Kaplan-Meier (KM) curves. Proportional hazards (PH) were assessed, and treatment effects were summarized using Fleming-Harrington weighted log-rank tests, a piecewise Cox summary, and restricted mean survival time (RMST) at a priori horizons. RESULTS: The reconstructed and published KM curves closely matched the trajectories, and the reconstructed Cox HR was consistent with the published HR. PH diagnostics suggested non-proportional hazards (global Schoenfeld test p = 0.001). The early-weighted Fleming-Harrington test showed the strongest separation (χ = 22.0, p < 0.001), whereas the late-weighted test did not provide confirmatory evidence (χ = 2.51, p = 0.110). RMST favored Lu-PSMA plus stereotactic body radiotherapy (relative difference in RMST (%) at 12 and 24 months, 43.7 [95% confidence interval: 24.9-65.3] and 67.8 [33.5-111], respectively). However, late follow-up estimates became increasingly imprecise as risk sets decreased. CONCLUSION: This reconstruction-based, hypothesis-generating reanalysis supported the primary inference of PFS benefit while suggesting time-varying effects. Weighted tests, piecewise summaries, and RMST may provide interpretable complements to a single HR. Late follow-up interpretation remains uncertain because of sparse late risk sets and events.
Preoperative non-contrast CT-derived adiposity quantity and attenuation predict recurrence-free survival after nephrectomy for localized clear cell renal cell carcinoma.
Ma Z, Kang L, Zheng Y … +4 more , Gong M, Li X, Ma J, Shang P
Int Urol Nephrol · 2026 Apr · PMID 41981362 · Publisher ↗
PURPOSE: To assess whether preoperative non-contrast CT-derived adiposity quantity and attenuation are independently associated with recurrence-free survival (RFS) after surgery for localized clear cell renal cell carcin...
PURPOSE: To assess whether preoperative non-contrast CT-derived adiposity quantity and attenuation are independently associated with recurrence-free survival (RFS) after surgery for localized clear cell renal cell carcinoma (ccRCC). METHODS: We performed a single-center retrospective cohort study of adults with pathologically confirmed ccRCC who underwent upfront partial or radical nephrectomy and had preoperative non-contrast abdominal CT within 30 days. A single mid-L3 axial slice was segmented for subcutaneous (SAT) and visceral adipose tissue (VAT) using predefined thresholds (SAT-190 to -30 HU; VAT-150 to-50 HU). Adiposity indices were normalized by height squared (SATI, VATI), and mean SAT/VAT attenuation (HU) was recorded. RFS was defined as time from surgery to first documented local/regional recurrence or distant metastasis. Multi-variable Cox models were adjusted for age, sex, chronic disease history, tumor diameter, surgery type, and WHO/ISUP grade; continuous predictors were standardized (per 1-SD). Incremental prognostic performance beyond the clinicopathologic base model was assessed using Harrell's C-index. RESULTS: Among 598 patients, 151 (25.3%) developed recurrence/metastasis. Higher SATI and VATI were associated with longer RFS in separate adjusted models (per 1-SD: SATI HR 0.55, 95% CI 0.44-0.68; VATI HR 0.63, 0.53-0.76). Higher (less negative) attenuation was associated with shorter RFS in separate adjusted models (SAT HU HR 1.29, 1.12-1.48; VAT HU HR 1.40, 1.21-1.60). In joint models, the SATI association remained robust, whereas VATI and VAT attenuation were attenuated. The apparent C-index of the clinicopathologic base model improved from 0.667 to 0.707 after adding SATI and to 0.713 after adding SATI + VATI. CONCLUSION: Routine preoperative non-contrast CT measures of adiposity quantity, and to a lesser extent attenuation, provide prognostic information for postoperative RFS in localized ccRCC. In this localized surgery-treated cohort, SATI was the most stable independent marker and modestly improved discrimination beyond clinicopathologic factors.
Telemedicine-supported assisted home hemodialysis in elderly and multimorbid patients: a real-world cohort study in a public healthcare system.
Zito A, Ria P, Lefons ML … +7 more , Martella V, Matino S, Fontò G, Barbarini S, Rollo T, Napoli M, De Pascalis A
Int Urol Nephrol · 2026 Apr · PMID 41964831 · Publisher ↗
PURPOSE: The aging of the hemodialysis (HD) population and the growing burden of multimorbidity increasingly challenge the sustainability and equity of conventional in-center dialysis within publicly funded healthcare sy...
PURPOSE: The aging of the hemodialysis (HD) population and the growing burden of multimorbidity increasingly challenge the sustainability and equity of conventional in-center dialysis within publicly funded healthcare systems. Although home hemodialysis (HHD) may offer clinical and organizational advantages, its implementation remains limited among elderly and functionally dependent patients. We evaluated the real-world feasibility, retention, and system-level impact of a telemedicine-supported assisted-HHD (A-HHD) program aimed at broadening access to complex individuals. We performed a retrospective, descriptive observational cohort study including all patients enrolled in an A-HHD program within a public healthcare authority in Southern Italy from June 2018 to June 2025. In September 2023, a structured telemedicine platform enabling real-time remote monitoring and audiovisual supervision was integrated into routine care. We assessed epidemiological trends, patient complexity, vascular access patterns, dialysis prescription and delivered dose, treatment retention, causes of discontinuation, and transportation-related economic outcomes. RESULTS: A total of 146 patients (mean age 79 ± 7 years) with substantial cardiovascular, metabolic, and respiratory comorbidity were treated. Central venous catheters were used in 64% of cases. Following early program expansion, annual incidence stabilized at approximately 20-25 patients, while prevalence steadily increased, exceeding 20 active patients per month. More than half of patients remained on therapy beyond 6 months. Despite shorter individual sessions, increased treatment frequency achieved a weekly standard Kt/V comparable to conventional in-center HD. Treatment discontinuation was predominantly related to mortality or clinical indications rather than program failure. CONCLUSION: Telemedicine-supported A-HHD represents a feasible and organizationally sustainable model capable of expanding equitable access to home-based dialysis while supporting organizational sustainability in public healthcare systems.
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