Int Urol Nephrol [JOURNAL]
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200 papers
From association to intervention: rethinking post-nephrectomy care in the COVID-19 era.
Han X, Lu K
Int Urol Nephrol · 2026 Apr · PMID 41961407 · Publisher ↗
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Perioperative outcomes following open radical cystectomy in the setting of locally advanced bladder cancer.
Russo P, Foschi N, Lentini N … +19 more , Bizzarri FP, Maioriello G, Ragonese M, Ciccarese C, Iacovelli R, Palermo G, Campetella M, Gandi C, Nigro D, Rossi F, Varacalli D, Pandolfo SD, Schubert O, Gavi F, Fettucciari D, Sighinolfi MC, Racioppi M, Sacco E, Rocco B
Int Urol Nephrol · 2026 Apr · PMID 41954691 · Publisher ↗
PURPOSE: To compare the perioperative outcomes and long-term survivors between localized (organ-confined cT2N0M0) and locally advanced (cT3-4 and/or cN1-3,M0) bladder cancer in patients undergoing radical cystectomy and...
PURPOSE: To compare the perioperative outcomes and long-term survivors between localized (organ-confined cT2N0M0) and locally advanced (cT3-4 and/or cN1-3,M0) bladder cancer in patients undergoing radical cystectomy and lymphadenectomy. METHODS: We conducted a retrospective observational cohort study including 364 consecutive patients who underwent open RC with urinary diversion at a high-volume tertiary referral center between July 2016 and November 2024. Patients were stratified according to pathological stage into localized disease (pT0-T2N0) and locally advanced disease (pT3-T4 and/or N1). Perioperative outcomes were evaluated using multivariable regression models. Overall survival (OS) was analyzed with Cox regression and Kaplan-Meier estimates. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were assessed using Fine-Gray competing-risks models. Propensity score matching (PSM) was performed as a sensitivity analysis. RESULTS: Among 364 patients, 203 had localized and 161 had locally advanced BCa. Locally advanced disease was associated with greater intraoperative blood loss (β 230 ml, 95% CI 89.9-370.3) and longer operative time (β 16.5 min, 95% CI 2.6-30.3), but postoperative complication rates were similar between groups. With a median follow-up of 54.9 months in localized and 36.4 months in locally advanced BCa, locally advanced disease was associated with significantly worse oncologic outcomes. Multivariable analyses confirmed higher risks of overall mortality (HR 3.40, 95% CI 2.40-4.81), recurrence (sHR 5.12, 95% CI 3.45-7.59), and cancer-specific mortality (sHR 2.26, 95% CI 1.43-3.59). Results were consistent after PSM. CONCLUSION: This study showed that, compared with localized disease, RC for locally advanced BCa was associated with similar 30-day mortality and major complication rates, but worse oncological outcomes. These findings support the perioperative feasibility of surgery in selected patients with locally advanced disease while underscoring their persistently poorer cancer prognosis.
Renal medullary carcinoma: a systematic review of clinical and radiological findings.
Weston W, Sit C, Dafydd DA … +7 more , Kelly-Morland C, Sohaib A, Adamane S, Manickavasagar T, Pickering L, Nicol D, Withey SJ
Int Urol Nephrol · 2026 Apr · PMID 41954690 · Publisher ↗
BACKGROUND AND AIMS: Renal medullary carcinoma (RMC) is a rare subtype of renal cell carcinoma, typically described in young patients with sickle cell trait, which follows an aggressive course. We aimed to perform a syst...
BACKGROUND AND AIMS: Renal medullary carcinoma (RMC) is a rare subtype of renal cell carcinoma, typically described in young patients with sickle cell trait, which follows an aggressive course. We aimed to perform a systematic review of all published cases of RMC from 1995 to 2024, to summarise the clinico-pathological and radiological features. METHODS: A systematic review of all published cases of RMC from 1995 to 2024 was performed. Patient demographics, clinical presentation, radiological features, metastatic profile, management, and overall survival were recorded. Sub-analysis was performed, grouped by sickle cell status. RESULTS: 219 cases from 103 articles were included, in addition to 5 previously unreported cases from our institution. 88% of patients had sickle cell haemoglobinopathy (SCH) (n = 168/192), with presentation at a younger age in patients with SCH (27.3 ± 13.7 versus 34.1 ± 19.1 years, p = 0.001). RMC was more frequently observed in the right kidney (64.6%, n = 122/189) than the left kidney (35.4%, n = 67/189) (p = < 0.001). Radiologically, the most common features were a central/endophytic location, hypo-enhancement relative to the adjacent cortex, and infiltrative margins. 20.7% (n = 42/203) were stage III at presentation and 70.9% (n = 144/203) of patients were Stage IV. Overall survival at 3 years was 74% for Stage I-II disease, 23% for Stage III disease, and 9% for Stage IV disease. CONCLUSIONS: Regardless of sickle cell status, RMC was shown to present at a relatively young age. It was classically seen as an infiltrative, poorly defined, endophytic tumour, centred on the renal medulla. RMC was found to be more commonly advanced at presentation and the overall survival in patients with nodal or distant metastases was poor.
The evolution of retrograde intrarenal surgery: a comprehensive meta-analysis of suction-assisted versus conventional techniques against mini-PCNL for 2-3 cm renal stones.
Liu R, Li Y, Zhang B … +4 more , Wang H, Wen H, Zhou Z, Zhang Y
Int Urol Nephrol · 2026 Apr · PMID 41954689 · Publisher ↗
OBJECTIVE: To evaluate the technological evolution of Retrograde Intrarenal Surgery (RIRS) by comprehensively comparing real-world and randomized outcomes of suction-assisted (SA-fURS) and conventional (C-fURS) technique...
OBJECTIVE: To evaluate the technological evolution of Retrograde Intrarenal Surgery (RIRS) by comprehensively comparing real-world and randomized outcomes of suction-assisted (SA-fURS) and conventional (C-fURS) techniques against Mini-Percutaneous Nephrolithotomy (mPCNL) for 2-3 cm renal stones. METHODS: A systematic search was performed in PubMed, Embase, Web of Science, Cochrane Library, and Scopus up to September 1, 2025. Randomized controlled trials (RCTs) and observational studies were included. Primary outcomes were immediate and final stone-free rates (SFR). Secondary outcomes included complications, operative time, and hospital stay. The certainty of evidence was assessed using the GRADE approach. RESULTS: Eighteen studies (4 RCTs, 14 non-RCTs) involving 3,832 patients were included. mPCNL provided higher immediate SFR (OR 0.41, low certainty). However, low-certainty evidence suggests the difference in final SFR between SA-fURS and mPCNL did not reach statistical significance (OR 0.77, P = 0.11), whereas C-fURS remained significantly inferior. RIRS demonstrated a superior safety profile with significantly lower risks of hemorrhage (OR 0.40, moderate certainty) and blood transfusion (OR 0.17, moderate certainty), and a shorter hospital stay (MD -2.26 days, very low certainty), despite longer operative times (MD 8.81 min, Very Low Certainty). CONCLUSION: While mPCNL provides superior immediate clearance, low-certainty evidence indicates no statistically significant difference in final stone-free rates between SA-fURS and mPCNL. Furthermore, SA-fURS demonstrates a favorable safety profile and faster recovery. Crucially, C-fURS remains significantly inferior in efficacy. These comprehensive findings validate recent randomized trials in a broader clinical context, establishing SA-fURS as a highly effective, minimally invasive alternative to mPCNL, whereas C-fURS should be considered a suboptimal choice for this stone burden.
Anatomical position as a predictor of hormonal therapy failure in palpable undescended testes.
Abdelmohsen A, Elshehawy N, Badawy R … +1 more , Sharaf S
Int Urol Nephrol · 2026 Apr · PMID 41949687 · Publisher ↗
BACKGROUND: Hormonal therapy for cryptorchidism shows limited long-term efficacy and is not routinely recommended by current guidelines, yet it continues to be used in practice. Evidence identifying anatomical subgroups...
BACKGROUND: Hormonal therapy for cryptorchidism shows limited long-term efficacy and is not routinely recommended by current guidelines, yet it continues to be used in practice. Evidence identifying anatomical subgroups with predictably poor outcomes remains limited. This study evaluated whether anatomical position predicts failure of hormonal therapy in palpable undescended testes. METHODS: This single-center retrospective cohort study included boys ≤ 14 years who received human chorionic gonadotropin (hCG) therapy for palpable undescended testes between 2015 and 2024. Testes were classified as high inguinal, low inguinal, external ring, or scrotal neck. The primary outcome was permanent testicular descent, defined as stable scrotal position for ≥ 6 months without re-ascent or orchidopexy. Multivariable logistic regression identified predictors of permanent descent. RESULTS: A total of 170 testes in 154 boys were analyzed. Overall permanent descent was achieved in 21.8%, with re-ascent occurring in 39.3% of initial responders, underscoring the importance of assessing durable rather than immediate outcomes. Success varied significantly by anatomical position (p < 0.001): external ring 50.0%, scrotal neck 38.1%, low inguinal 16.7%, and high inguinal 3.6%. Testes above the external ring accounted for 77% of treatment failures; additionally, 78.2% of testes ultimately required orchidopexy. Anatomical position was the strongest predictor of permanent descent, with markedly reduced odds for low inguinal (adjusted OR 0.19) and high inguinal (adjusted OR 0.04) positions compared with external ring. CONCLUSIONS: Hormonal therapy failure in palpable undescended testes is highly predictable based on anatomical position. High and low inguinal testes demonstrate negligible to poor durable benefit, and orchidopexy should generally be preferred over hormonal therapy trials in these positions, though shared decision-making with families remains appropriate. External ring and scrotal neck testes represent the only subgroups in which selective hormonal therapy may be considered through shared decision-making with families. These findings refine guideline-based management by identifying where hormonal therapy should generally be avoided to prevent futile treatment.
Methodological considerations regarding confounding and multivariable adjustment in evaluating SGLT2 inhibitors in systemic lupus erythematosus?
Shaikh R
Int Urol Nephrol · 2026 Apr · PMID 41945246 · Publisher ↗
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Evaluation of the applicability of AI chatbots in addressing health management issues for living kidney donors.
Wang X, Yu K, Zhao J … +1 more , Shi Y
Int Urol Nephrol · 2026 Apr · PMID 41945245 · Publisher ↗
BACKGROUND: Living kidney donors (LKDs) encounter significant health issues and increasingly use AI chatbots for medical information. However, the effectiveness of these chatbots in providing relevant and accurate health...
BACKGROUND: Living kidney donors (LKDs) encounter significant health issues and increasingly use AI chatbots for medical information. However, the effectiveness of these chatbots in providing relevant and accurate health guidance for LKDs remains underexplored. METHODS: We assessed four chatbots-ChatGPT-3.5, ChatGPT-4, Copilot, and Bard-on their responses to health-related questions for LKDs. Using Google search queries related to kidney donation from the top ten countries in transplants (2015-2019), we generated a list of "Frequently Asked Questions" via the Keyword Magic Tool and literature review. Questions were submitted to the chatbots between November 10 and 12, 2024. Responses were evaluated by six experts on accuracy, integrity, comprehensibility, and operability using a five-point Likert scale. RESULTS: The "frequently asked questions" developed in this study consisted of five health-related topics comprising a total of 29 items. Among the four AI chatbots, only Copilot failed to respond to 2 out of the 29 questions (6.9%), exhibiting the lowest performance in both accuracy [3.35 (3.18, 3.52)] and integrity [3.40 (3.09, 3.71)]. In contrast, ChatGPT-4.0 achieved the highest median accuracy [4.05 (3.89, 4.21)] and integrity [4.00 (3.82, 4.18)], closely followed by ChatGPT-3.5[4.01 (3.88, 4.16)], [3.98 (3.85, 4.11)]. Overall, all chatbots demonstrated high levels of language comprehensibility and operability. CONCLUSION: AI chatbots showed potential as supplementary tools for managing the health of LKDs, with ChatGPT-4.0 being the preferred option. However, notable variations in accuracy and integrity underscore the need for effective pre-training, robust oversight, and repeated validation of the information they provide. Relevance to clinical practice (a) The identification of a diverse and detailed "Frequently Asked Questions" list for LKDs. Healthcare providers and support organizations should use this list to develop targeted educational materials and interventions that address the specific health inquiries of LKDs, especially concerning the management of common abnormal symptoms. (b) Enhancing LKD Support. The findings underscore the potential of AI chatbots, particularly ChatGPT-4.0, as valuable supplementary tools for addressing health inquiries among LKDs. Unlike FAQ-based static resources, chatbots provide dynamic, on-demand support for unpredictable health scenarios. Integrating these chatbots into patient education and support systems could enhance information accessibility and empower LKDs in managing their health.
Danish National Penile Cancer Database, DaPeCa-data: characteristics, management, and survival 2000-2025.
Mølsted J, Als AB, Jensen JB … +2 more , Aagaard M, Jakobsen JK
Int Urol Nephrol · 2026 Apr · PMID 41941068 · Publisher ↗
PURPOSE: To present the characteristics of Danish penile cancer patients, treatment strategies, and prognosis. METHODS: The Danish National Penile Cancer database currently contains information on 1,397 patients with pen...
PURPOSE: To present the characteristics of Danish penile cancer patients, treatment strategies, and prognosis. METHODS: The Danish National Penile Cancer database currently contains information on 1,397 patients with penile cancer referred to a university center from 2000 to 2025. The database was established by retrospective medical chart review. The set of variables were defined by the Danish Multidisciplinary Cancer Group, DaPeCa. KEY FINDINGS: Between 2000 and 2025, 1,397 patients with penile cancer were evaluated at a tertiary Danish center; 1,200 (86%) were treated with curative intent. Most patients presented with pT1-2 disease (79%), while 206 (15%) had pN3 disease and 47 (3.4%) had distant metastases at diagnosis. Surgical nodal staging was performed in 87% of patients. Organ-preserving treatment was used in 47% of curatively treated patients and in 75% of pT1 tumors. The overall 5-year cumulative incidence (CI) of penile cancer-specific death was 16% (95% CI 14-19), compared with 11% (95% CI 8.8-13) among curatively treated patients and 53% (95% CI 45-60) in non-curative cases. Mortality increased markedly with disease stage, reaching a CI of 58% in AJCC stage IV and 83% in patients with distant metastases. In multivariable analyses, higher T stage and nodal stage were the strongest predictors of disease-specific survival. CONCLUSION: 45% of patients were diagnosed with pT1 tumors, 27% presented with nodal metastases (pN +), and 3.4% had distant metastases at diagnosis. Overall 5-year cumulative incidence of penile cancer-specific death was 16% (14%, 19%). Most patients were treated with curative intent and achieved favorable survival outcomes. T stage and nodal stage were the strongest independent predictors of disease-specific survival.
Transrectal ultrasonography provides enhanced detection of distal ureteral stones compared to conventional imaging modalities.
Nariyoshi S, Nishimura H, Tsuji Y
Int Urol Nephrol · 2026 Apr · PMID 41936696 · Publisher ↗
PURPOSE: Non-contrast computed tomography (CT) is widely regarded as the gold standard for diagnosing ureteral stones; however, CT is not always immediately accessible in all clinical settings. Transrectal ultrasonograph...
PURPOSE: Non-contrast computed tomography (CT) is widely regarded as the gold standard for diagnosing ureteral stones; however, CT is not always immediately accessible in all clinical settings. Transrectal ultrasonography (TRUS) enables direct visualization of the distal ureter and may enhance diagnostic confidence during the initial evaluation of suspected distal ureteral stones. This study evaluated the clinical diagnostic performance of TRUS compared with conventional imaging modalities. METHODS: This retrospective study included 215 consecutive patients with suspected distal ureteral stones who underwent kidney-ureter-bladder radiography (KUB), intravenous urography (IVU), abdominal ultrasonography (US), and TRUS on the same day. Stone diagnosis was confirmed by spontaneous passage during follow-up (stone-positive group, n = 186), while 29 patients were classified as stone-negative. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each modality. Comparisons were performed using McNemar's test. RESULTS: Among stone-positive patients, KUB detected stones in 138 (74.2%), IVU in 148 (79.6%), abdominal US in 129 (69.4%), and TRUS in 184 (98.9%). False-positive findings occurred in six cases with KUB and nine with IVU, whereas none were observed with abdominal US or TRUS. TRUS demonstrated the highest sensitivity (98.9%) and specificity (100%), with a markedly superior NPV (93.5%). TRUS detected distal ureteral stones significantly more frequently than KUB and IVU (both p < 0.001). CONCLUSION: TRUS is an effective imaging modality for detecting distal ureteral stones during initial evaluation and may serve as a valuable adjunct, particularly in clinical settings where immediate access to CT is limited.
Immunohistochemical assessment of vimentin expression and Ki-67 proliferation index in conventional urothelial carcinoma: a study of 60 Egyptian patients.
Youssef HMK, Ibrahim EH, Hasan A … +11 more , Samman A, Abdelwahed MS, Baloush RA, Noorwali H, Abu Al-Teen D, El Bostany MZ, Nasr A, Samir M, Mandour E, Rabie A, Shokery SEM
Int Urol Nephrol · 2026 Apr · PMID 41936003 · Publisher ↗
BACKGROUND: Urothelial carcinoma is a common malignancy with a substantial burden, including in Egypt. Although Ki-67 and EMT-related markers such as vimentin have been previously studied, region-specific validation and...
BACKGROUND: Urothelial carcinoma is a common malignancy with a substantial burden, including in Egypt. Although Ki-67 and EMT-related markers such as vimentin have been previously studied, region-specific validation and practical cutoff performance remain relevant.Author names: Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Also, kindly confirm the details in the metadata are correct. We have made the requested corrections. In addition, we would like to change the author order so that Deema Abu Al-Teen is listed as author number 4, and Abdulhadi Samman is moved to author number 8 in her place, with the same affiliation as currently shown related to each author, Samman (Jeddah) and Abu Al-Teen (Amman). METHODS: This cross-sectional study included 60 archival conventional UC cases diagnosed at university hospitals during 2024. Tumors were re-reviewed to confirm grade and stage and categorized as NMIBC or MIBC. Immunohistochemistry was performed for vimentin and Ki-67 (MIB-1). Vimentin was considered positive when ≥ 10% of tumor cells showed convincing cytoplasmic staining. The Ki-67 labeling index was assessed in hotspots by counting ≥ 500 tumor nuclei and categorized as low (< 30%) versus high (≥ 30%) using a predefined pragmatic cutoff. Multivariable logistic regression was used to identify independent predictors of high-grade disease. RESULTS: Vimentin positivity was detected in 18/60 cases (30.0%), and high Ki-67 index was present in 37/60 (61.7%). High Ki-67 independently predicted high-grade carcinoma (OR = 5.601, p = 0.009) and was significantly associated with high grade (p = 0.011), non-papillary pattern (p < 0.001), and muscle invasion (p = 0.001), but not lymphovascular invasion (p = 0.405). Vimentin showed no significant associations and was not an independent predictor; Ki-67 and vimentin were not significantly correlated. CONCLUSION: In this Egyptian cohort, Ki-67 ≥ 30% was strongly associated with adverse pathological features and independently predicted high-grade disease, supporting its use as a practical ancillary marker and providing regional validation of prior reports. Vimentin was not significantly associated with the studied parameters in this dataset. Future studies should assess alternative cutoffs within the same cohort and validate outcome-linked thresholds in longitudinal datasets.
MiR-423-5p inhibition alleviates podocyte apoptosis in membranous nephropathy by targeting WT1/β-catenin axis.
Liu H, Zhang S, Zhao XN … +3 more , Wang ZZ, Song JN, Liu SX
Int Urol Nephrol · 2026 Apr · PMID 41934575 · Publisher ↗
PURPOSE: Membranous nephropathy (MN) is the most common pathological type of primary nephrotic syndrome in adults. MicroRNAs (miRNAs) are involved in the pathogenesis of several renal diseases. Here we investigated the p...
PURPOSE: Membranous nephropathy (MN) is the most common pathological type of primary nephrotic syndrome in adults. MicroRNAs (miRNAs) are involved in the pathogenesis of several renal diseases. Here we investigated the potential involvement of miRNAs in MN progression. METHODS: miRNA sequencing was performed in the urinary exosomes of MN patients and normal controls (three cases per group). An experimental mouse MN model induced by cationic bovine serum albumin (CBSA) and MPC5 podocytes intoxicated by puromycin aminonucleoside (PAN) were used in this study. RESULTS: Compared with the normal controls, 19 miRNAs were downregulated and 13 upregulated in the urinary exosomes of MN patients. In an expanded cohort, we confirmed that miR-423-5p was significantly upregulated in the urinary exosomes of MN patients. Urinary particle concentrations and size distribution were assessed using transmission electron microscopy and NanoSight. Similarly, upregulated miR-423-5p was observed in PAN-intoxicated MPC5 cells. Lentiviral vector-mediated inhibition of miR-423-5p suppressed podocyte apoptosis and inactivated β-catenin signaling. Upon miRNA database prediction, WT1 was identified as a target of miR-423-5p. Consistently, downregulated WT1 expression in PAN-intoxicated MPC5 cells was rescued by miR-423-5p inhibition. The target relationship between miR-423-5p and WT1 mRNA 3'UTR was validated by the dual luciferase reporter assay. Knockdown of WT1 reversed the inhibitory effect of LV-anti-miR-423-5p on podocyte apoptosis and β-catenin signaling. Notably, miR-423-5p inhibition and WT1 overexpression attenuated renal injury and podocyte apoptosis in MN mice. CONCLUSION: Our study demonstrates that miR-423-5p expression is upregulated in urinary exosomes of MN patients and modulates WT1, affecting podocyte apoptosis by the β-catenin signaling pathway. Inhibition of miR-423-5p action may protect against MN.
Tumor-draining lymph nodes as immunologic hubs: rethinking nodal surgery in the era of checkpoint blockade in urologic cancers.
Yamamoto S, Higa K, Kurokawa K … +3 more , Bamba H, Kanaoka S, Nakamura K
Int Urol Nephrol · 2026 Apr · PMID 41933077 · Publisher ↗
Extended lymph node dissection (LND) is central to curative-intent surgery and pathological staging in urologic oncology, yet randomized trials rarely demonstrate a survival benefit for broader templates, while lymphatic...
Extended lymph node dissection (LND) is central to curative-intent surgery and pathological staging in urologic oncology, yet randomized trials rarely demonstrate a survival benefit for broader templates, while lymphatic morbidity increases. Tumor-draining lymph nodes (TDLNs) function as immunologic hubs that prime tumor-specific T cells and can sustain immune checkpoint inhibitor (ICI)-responsive progenitor populations, although metastatic TDLNs also develop immunosuppressive dysfunction. This review synthesizes contemporary clinical evidence on LND across major urologic malignancies and integrates these findings with emerging TDLN biology, including progenitor-exhausted CD8⁺ T-cell programs and tertiary lymphoid structures relevant to ICI responses. We highlight that the incremental oncologic benefit of extended LND is often modest and disease-specific, whereas pathology-negative regional nodes may contribute to ICI responsiveness by maintaining T-cell reservoirs. Furthermore, we discuss selective nodal strategies-such as sentinel/index node concepts, targeted nodal sampling, and advances in imaging and AI-assisted radiomics-that are intended to preserve staging accuracy and local control, while limiting morbidity and avoiding unselective disruption of potentially immunologically active nodal basins. We conclude that prospective perioperative immunotherapy studies should explicitly evaluate the extent and timing of nodal surgery as biologically relevant variables and incorporate prespecified immune correlates alongside clinical endpoints. Specifically, we propose prospective trial designs that compare upfront standard-template dissection with neoadjuvant ICI followed by response‑adapted selective nodal sampling. These studies should incorporate robust clinical endpoints-such as event‑free survival and lymphatic morbidity-together with prespecified translational immune correlates, including progenitor‑exhausted T‑cell dynamics and circulating tumor DNA.
External mechanical vibration as an adjunct to medical expulsive therapy for distal ureteral stones ≤ 10 mm: a prospective cohort study.
Sevim M, Durmus E
Int Urol Nephrol · 2026 Apr · PMID 41931264 · Publisher ↗
PURPOSE: To evaluate whether externally applied mechanical vibration (an EPVL-based approach) improves stone passage when used as an adjunct to medical expulsive therapy (MET) in patients with distal ureteral stones ≤ 10...
PURPOSE: To evaluate whether externally applied mechanical vibration (an EPVL-based approach) improves stone passage when used as an adjunct to medical expulsive therapy (MET) in patients with distal ureteral stones ≤ 10 mm. METHODS: In this prospective observational cohort study, 697 patients with unilateral distal ureteral stones were stratified by size (≤ 5 mm vs > 5 mm) and managed with observation, tamsulosin-based MET, externally applied mechanical vibration (an EPVL-based approach), or vibration combined with MET. The primary endpoint was cumulative stone passage within 4 weeks. Secondary endpoints included complications (Clavien-Dindo classification) and requirement for ureterorenoscopy (URS). RESULTS: EPVL-based strategies were associated with higher early stone passage rates in both size groups. In stones ≤ 5 mm, final stone-free rates were high across all strategies (83.3-95.3%; p = 0.081), suggesting a primary effect on time to passage. In stones > 5 mm, week-4 stone-free rates were significantly higher with MET (78.3%), EPVL (81.0%), and EPVL + MET (88.4%) compared with observation (53.9%) (p < 0.001). Complication rates were higher in stones > 5 mm than in ≤ 5 mm (13.7% vs 4.6%; p < 0.001), without significant differences between management strategies. CONCLUSION: Externally applied mechanical vibration may serve as a safe and pragmatic noninvasive adjunct to MET. It was associated with faster stone passage and higher stone-free rates in distal ureteral stones > 5 mm without an apparent increase in complication risk.
Glomerular diseases in South African patients on kidney replacement therapy: an analysis of 2022 South African Renal Registry data.
Fitchat NA, Davids MR, Chothia MY
Int Urol Nephrol · 2026 Apr · PMID 41927893 · Publisher ↗
BACKGROUND: Kidney failure is a growing public health burden in sub-Saharan Africa, with limited access to kidney replacement therapy (KRT) and a paucity of epidemiological data, particularly on glomerular disease as an...
BACKGROUND: Kidney failure is a growing public health burden in sub-Saharan Africa, with limited access to kidney replacement therapy (KRT) and a paucity of epidemiological data, particularly on glomerular disease as an underlying cause. The primary aim of our study was to describe the types of glomerular diseases in prevalent patients receiving KRT in South Africa. METHODS: We conducted a cross-sectional study of South African prevalent patients who were receiving KRT on 31 December 2022 who had glomerular disease as a cause of their kidney failure, as recorded in the South African Renal Registry (SARR). Patients were categorised by glomerular disease subtype, demographic data, KRT modality, sector of care and geographic distribution. RESULTS: Of the 9342 patients on KRT, 2135 (22.9%) had glomerular disease as a cause of kidney failure. The median age was 55 years (interquartile range: 42-65 years), with a male predominance (56.9%). Secondary glomerular diseases accounted for 67.9% and diabetic nephropathy (56.1%) was the most common, followed by human immunodeficiency virus-associated nephropathy (4.8%) and lupus nephritis (4.5%). Of the primary glomerular diseases, focal segmental glomerulosclerosis (7.7%) was the most common, followed by IgA nephropathy (5.3%), rapidly progressive glomerulonephritis (4.8%) and mesangiocapillary glomerulonephritis (3.8%). CONCLUSIONS: Nearly one-quarter of patients receiving KRT in South Africa have glomerular disease as a cause of their kidney failure, with secondary forms predominating. The high prevalence of diabetic nephropathy underscores the substantial contribution of diabetes mellitus to the burden of kidney failure. Marked disparities were observed between healthcare sectors.
The impact of frailty on the survival prognosis of maintenance hemodialysis patients and the construction and validation of a survival prediction model.
Liu Y, Liu J, Hou S … +2 more , Chang L, Wu H
Int Urol Nephrol · 2026 Apr · PMID 41926005 · Publisher ↗
OBJECTIVE: This study aims to examine the impact of frailty on the survival outcomes of patients undergoing maintenance hemodialysis (HD) and to develop a predictive model for mortality risk. METHODS: In this prospective...
OBJECTIVE: This study aims to examine the impact of frailty on the survival outcomes of patients undergoing maintenance hemodialysis (HD) and to develop a predictive model for mortality risk. METHODS: In this prospective cohort study, 400 HD patients were enrolled and followed for 24 months. Frailty was assessed by the Fried phenotype. Depression and anxiety were evaluated using the PHQ-9 and GAD-7 scales, respectively. Patients were randomly split into a model development group (n = 280) and a validation group (n = 120). Kaplan-Meier curves and the log-rank test were used for survival analysis. Independent predictors were identified using LASSO-Cox regression to construct a nomogram. Model performance was evaluated using the C-index, calibration curves, and decision curve analysis (DCA). RESULTS: The prevalence of frailty was 45.75%. Multivariable analysis identified frailty (HR = 1.85, 95% CI 1.03-3.36), age (HR = 1.04, 95% CI 1.01-1.07), depression (HR = 4.91, 95% CI 2.00-12.04), anxiety (HR = 3.49, 95% CI 1.78-6.83), cardiovascular disease (HR = 2.06, 95% CI 1.13-3.78), serum creatinine (HR = 1.004, 95% CI 1.003-1.005), and total cholesterol (HR = 1.50, 95% CI 1.13-2.00) as independent risk factors (all P < 0.05). The model demonstrated a C-index of 0.903. In the validation cohort, the AUCs were 0.889 (6-month), 0.897 (1-year), and 0.941 (2-year). Calibration and DCA confirmed good accuracy and clinical utility. CONCLUSION: Frailty is prevalent and independently associated with mortality in HD patients. The developed nomogram provides an accurate tool for individualized risk prediction. The particularly strong influence of depression and anxiety on survival underscores the critical need for integrating routine psychological screening into the clinical management of hemodialysis patients.
Transcatheter vs surgical aortic valve replacement in young adults with chronic kidney disease: a national inpatient comparison of in-hospital outcomes.
Maniya MT, Aisha E, Ahmad A … +12 more , Saleem H, Awan AR, Manzoor I, Lohana S, Zainab A, Amir R, Ul Ain N, Tariq L, Zahid A, Arif A, Akbar O, Mattumpuram J
Int Urol Nephrol · 2026 Apr · PMID 41922882 · Publisher ↗
BACKGROUND: Chronic Kidney Disease (CKD) is a major global health problem, burdening more than 650 million people worldwide and exposing them to the risk of aortic stenosis (AS). The present study responds to the urgent...
BACKGROUND: Chronic Kidney Disease (CKD) is a major global health problem, burdening more than 650 million people worldwide and exposing them to the risk of aortic stenosis (AS). The present study responds to the urgent need to assess the safety and effectiveness of aortic valve replacement (AVR) interventions young adults with CKD, who tend to be excluded from randomized trials. METHODS: We analyzed the in-hospital outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in a young adult population with chronic kidney disease (CKD) using the National Inpatient Sample (NIS) database. This large, publicly available United States inpatient healthcare database allowed cross-sectional analysis of hospital admissions during 2018-2020. The population included patients under the age of 65 with a primary or secondary CKD diagnosis who underwent TAVR or SAVR procedures. Baseline factors and in-hospital outcomes, such as mortality rates, hospital costs, and hospital stay, were compared between the TAVR and SAVR groups using statistical analysis, adjusting for these baseline factors. RESULTS: The 11,315 young adults with CKD trial revealed that TAVR was associated with comparable risk of in-hospital death, reduced length of hospital stay, and decreased hospital charges in comparison to SAVR. TAVR was also associated with reduced risk of acute kidney injury, cardiogenic shock, and venous thromboembolism complications. CONCLUSIONS: In conclusion, TAVR presents a favorable alternative to SAVR for young adults with CKD. These findings contribute strong evidence to guide clinical decision-making and improve care for this complex patient population.
Safety and efficacy of adding voclosporin to standard treatment of lupus nephritis in adult patients: a meta-analysis and time-to-event analysis of randomized controlled trials.
Sayed MS, Murad MR, Kareem HN … +5 more , Belabaci Z, Abdelhamid MT, Humade SH, Abdullah L, Abdulazeem H
Int Urol Nephrol · 2026 Apr · PMID 41922881 · Publisher ↗
BACKGROUND: Lupus Nephritis (LN) is one of the most common complications of systemic lupus erythematosus. Recent primary studies have stated the superiority of adding voclosporin to standard treatment regimens in reducin...
BACKGROUND: Lupus Nephritis (LN) is one of the most common complications of systemic lupus erythematosus. Recent primary studies have stated the superiority of adding voclosporin to standard treatment regimens in reducing proteinuria in LN patients. In this meta-analysis, we evaluate the safety and efficacy of combining voclosporin in patients with LN. METHODS: We searched PubMed, Embase, Scopus, and Web of Science on February 25, 2025, to identify randomized controlled trials (RCTs) that compared the use of voclosporin with standard treatment versus placebo. The Cochrane ROB 2.0 tool was used to assess the quality of the included studies. Cumulative hazard ratio (HR) and risk ratio (RR) with their corresponding 95% confidence intervals (CI) were calculated using R and RevMan software. RESULTS: 770 patients with LN were included in the three RCTs, with a mean age of 33.01(SD, 9.94) years. Voclosporin significantly achieved a higher reduction of the urine protein-to-creatinine ratio (UPCR) below 50% of its baseline value [HR: 1.97, 95% CI 1.66 to 2.35, log-rank p < 0.001], and below 0.5 g/g [HR: 1.84, 95% CI 1.43 to 2.37, log-rank p < 0.001] compared to placebo. There were higher complete and partial response rates at 6 months and 12 months in the voclosporin group, respectively. The overall adverse events and treatment-related serious adverse events significantly increased in the voclosporin group, which increases the clinical concerns of using voclosporin in LN patients. CONCLUSION: This analysis highlights the superior efficacy outcomes of voclosporin in inducing LN remission and reducing proteinuria. However, the risk of adverse effects was higher when voclosporin was used. Larger primary studies are needed to explore its exact safety profile.
The impact of size: a systematic review and meta-analysis of tubeless versus standard percutaneous nephrolithotomy in 2171 adult patients.
Palacios-Navas AG, Esparza-Miranda LA, Campos-Muñoz AJ … +5 more , Flores-Bravo Y, Calderón-Fernández A, de la Luz Nevárez-Rivera M, Sánchez-Villacrés FR, Calvillo-Ramirez A
Int Urol Nephrol · 2026 Mar · PMID 41917379 · Publisher ↗
PURPOSE: Percutaneous nephrolithotomy (PCNL) with nephrostomy drainage remains the standard treatment for large and complex renal calculi; however, the comparative effectiveness of tubeless PCNL versus standard PCNL, par...
PURPOSE: Percutaneous nephrolithotomy (PCNL) with nephrostomy drainage remains the standard treatment for large and complex renal calculi; however, the comparative effectiveness of tubeless PCNL versus standard PCNL, particularly across different nephrostomy tube sizes, remains uncertain.This meta-analysis focuses on comparing T-PCNL versus S-PCNL across nephrostomy bore sizes to provide a comprehensive evaluation of outcomes. METHODS: We conducted a comprehensive database search until July 2024, focusing on randomized controlled trials (RCTs) that compared T-PCNL and S-PCNL. We included studies that reported outcomes related to operative time, stone-free rate (SFR), post-operative complications, and length of hospital stay. Results were expressed as standardized mean differences (SMD), mean differences (MD), and risk ratios (RR), with 95% confidence intervals (CI). RESULTS: Twenty-eight RCTs comprising 2,171 patients were included. T-PCNL significantly reduced hospital stay (SMD = -1.12; p < 0.00001), analgesic use (SMD = -1.01; p < 0.00001), and postoperative pain (SMD = -1.05; p = 0.01), particularly when compared to medium and large bore tubes. No significant differences were found in SFR (RR = 1.03; p = 0.15), transfusion, urosepsis, or Clavien-Dindo grade II-IV events. Operative time and residual stone burden were also lower with T-PCNL. CONCLUSION: T-PCNL is a safe and effective alternative to S-PCNL, offering faster recovery and fewer postoperative symptoms. Its benefits are most pronounced when compared to larger bore nephrostomy tubes, supporting its broader adoption in appropriately selected patients.
Association of electronic cigarette and conventional smoking with urogenital cancers: NHIS analysis.
Bakhsh A, Abdullah S, Farghal DM … +3 more , Badawi AS, Rajih E, Alnazari M
Int Urol Nephrol · 2026 Mar · PMID 41917378 · Publisher ↗
The main goal of this analysis is to investigate the association between electronic cigarette (e-cigarette) use, conventional cigarette smoking, and the development of bladder and prostate cancers. This retrospective stu...
The main goal of this analysis is to investigate the association between electronic cigarette (e-cigarette) use, conventional cigarette smoking, and the development of bladder and prostate cancers. This retrospective study utilizes data from the National Health Interview Survey (NHIS), collected between 2020 and 2022. The analysis included 88,701 participants, among whom 326 were diagnosed with bladder cancer and 1,399 with prostate cancer. Associations were evaluated using logistic regression analyses, adjusted for relevant confounding variables. Conventional cigarette smoking was significantly associated with increased odds of both bladder (adjusted OR = 3.92, 95% CI: 3.07-5.00) and prostate cancers (adjusted OR = 1.42, 95% CI: 1.27-1.59). Initially, e-cigarette use showed an inverse association with these cancers in unadjusted analyses, which continued with bladder cancer upon adjustment (OR = 0.43, 95% CI: 0.29-0.63), but it was no longer significant after adjustment for prostate cancer (p = 0.84). Hypertension and diabetes appeared as significant independent risk factors for bladder cancer, whereas age, hypertension, and obesity were associated with increased odds of prostate cancer. This study highlights the strong association between conventional cigarette smoking and urogenital cancers and identifies risk factors such as hypertension, diabetes, and obesity for targeted cancer prevention. The potential long-term risks associated with e-cigarette use require further investigation through longitudinal studies.
Comment on "Dialysis versus conservative kidney management in older adults: why one size does not fit all".
Alp A
Int Urol Nephrol · 2026 Mar · PMID 41915106 · Publisher ↗
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