The Canadian Journal Of Urology[JOURNAL]
Sun
200 papers
Smarter, Not More: The Rationale for Reducing Systematic Cores in the MRI-Targeted Biopsy Era.
Lv Z, Xu Y, Jiang X
Can J Urol · 2026 Feb · PMID 42179029 · Publisher ↗
Abstract loading — click title to view on PubMed.
Ten Years of Progress in Advanced Prostate Cancer at the AUA.
Gomella LG
Can J Urol · 2026 Apr · PMID 42179026 · Publisher ↗
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Electroacupuncture for sperm improvement in varicocele: a case report.
Nurwati I, Budihastuti UR, Murti B … +2 more , Prakosa T, Sukmawati M
Can J Urol · 2026 Apr · PMID 42086366 · Publisher ↗
BACKGROUND: Varicocele is a common cause of male infertility, often associated with impaired sperm quality, hormonal imbalance, and increased DNA fragmentation. Electroacupuncture (EA) has been proposed as an adjunct the...
BACKGROUND: Varicocele is a common cause of male infertility, often associated with impaired sperm quality, hormonal imbalance, and increased DNA fragmentation. Electroacupuncture (EA) has been proposed as an adjunct therapy to improve reproductive parameters, but clinical evidence remains limited. CASE DESCRIPTION: This case report describes a 38-year-old male with a varicocele treated at Dr. Moewardi General Hospital, Indonesia. The patient underwent 16 sessions of EA therapy. Sperm parameters and serum testosterone levels were measured before and after treatment. Following EA, sperm concentration improved from 5.2 to 6.7 × 106/mL, motility increased from 43% to 60%, and normal morphology rose from 1% to 3%. Testosterone levels increased from 329.6 to 596.2 ng/dL, while the DNA Fragmentation Index (DFI) decreased from 40% to 19.6%. CONCLUSIONS: This case suggests that EA therapy may improve sperm quality, enhance testosterone levels, and reduce DFI in a patient with varicocele. However, further controlled studies are needed to confirm these findings due to the limitations of a single case report.
Transperineal approach for penetrating injury of corpus spongiosum and bulbous urethra caused by vesicourethral foreign body: a case report.
Yanagida K, Watanabe D, Inoue H … +2 more , Ujiie T, Mizushima A
Can J Urol · 2026 Apr · PMID 42086365 · Publisher ↗
BACKGROUND: Vesicourethral foreign bodies are frequently encountered in urological emergency departments; however, cases of penetrating injury to the corpus spongiosum penis and bulbous urethra are rare. CASE DESCRIPTION...
BACKGROUND: Vesicourethral foreign bodies are frequently encountered in urological emergency departments; however, cases of penetrating injury to the corpus spongiosum penis and bulbous urethra are rare. CASE DESCRIPTION: A 64-year-old man presented with difficulty removing a foreign body that he had inserted into his urethra for masturbation. Abdominal computed tomography (CT) revealed a rod-shaped foreign body lodged from the bulbous urethra to the posterior wall of the bladder. Cystoscopy confirmed penetration of the foreign body into the urethral sponge at the bulbous urethra. An attempt was made to remove the foreign body transurethrally, but it was unsuccessful, leading to the establishment of a cystostomy and subsequent hospitalization. Under general anesthesia, the foreign object was removed through a perineal incision, revealing a bamboo skewer with an attached rubber tube. No postoperative complications were noted. Urethrography performed six months postoperatively showed no urethral stricture, and the patient established spontaneous urination without erectile or ejaculatory dysfunction. CONCLUSIONS: In cases of penetrating urethral injury, where the wound is often sharp, perineal surgery should be considered on par with the transurethral approach, as it does not affect the patient's postoperative quality of life if infection complications are monitored carefully.
Penile fracture and concomitant severe urethral trauma-a case report and discussion of surgical approach.
Samaras A, Aufderklamm S, Amend B … +4 more , Stühler V, Stenzl A, Tsaur I, Rausch S
Can J Urol · 2026 Apr · PMID 42086364 · Publisher ↗
BACKGROUND: Penile fracture is a rare urological emergency, especially when it involves a urethral injury. CASE DESCRIPTION: Here, we report the case of a 41-year-old male patient with penile trauma during sexual interco...
BACKGROUND: Penile fracture is a rare urological emergency, especially when it involves a urethral injury. CASE DESCRIPTION: Here, we report the case of a 41-year-old male patient with penile trauma during sexual intercourse, presenting with typical clinical signs of corpus cavernosum rupture and gross hematuria. Emergency surgical exploration revealed an additional partial urethral injury (approximately 1.5 cm in length), which was primarily closed. Surgical management included a vertical penoscrotal incision, evacuation of hematoma, double-layer re-approximation of the urethra, closure of the tunica albuginea, and placement of both transurethral and suprapubic catheters. The postoperative course was uneventful, with diazepam administered to suppress erections and full functional recovery at 6-month follow-up. CONCLUSION: This case highlights the importance of prompt diagnosis, a tailored surgical approach, and urinary diversion in the setting of urethral trauma.
Management of retained bullet fragments from posterior urethra after gunshot wound: a case report.
Kodres-O'Brien SM, Koellermeier M, Shah N … +1 more , Langenstroer P
Can J Urol · 2026 Apr · PMID 42086363 · Publisher ↗
BACKGROUND: Retained bullet fragments in the genitourinary tract following gunshot wound is rare and require removal. CASE DESCRIPTION: We present the case of a retained bullet in the prostate following a gunshot wound t...
BACKGROUND: Retained bullet fragments in the genitourinary tract following gunshot wound is rare and require removal. CASE DESCRIPTION: We present the case of a retained bullet in the prostate following a gunshot wound to the pelvis, which was endoscopically removed. A urethral catheter and suprapubic tube were placed. The patient then had migration of a second bullet fragment into the prostatic urethra six weeks later, requiring open removal. CONCLUSIONS: This case shows that several approaches can be considered to remove retained bullet fragments from the urinary tract. Furthermore, access to the bladder via a suprapubic tube can be beneficial.
Robot-assisted partial nephrectomy during simultaneous extracorporeal membrane oxygenation and impella®in a candidate for left ventricular assist device as a bridge for cardiac transplant: a case report.
Cianflone F, Cirulli GO, Villano A … +11 more , Ali ME, Belliato M, Veronesi R, Bichisao G, Marchetti C, Secondino S, Pedrazzoli P, Pelenghi S, Pellegrini C, Ringressi A, Naspro R
Can J Urol · 2026 Apr · PMID 42086362 · Publisher ↗
BACKGROUND: Robot-assisted partial nephrectomy (RAPN) is standard for cT1 renal masses, but its feasibility in patients on temporary mechanical circulatory support is poorly documented. We report RAPN performed while a p...
BACKGROUND: Robot-assisted partial nephrectomy (RAPN) is standard for cT1 renal masses, but its feasibility in patients on temporary mechanical circulatory support is poorly documented. We report RAPN performed while a patient was simultaneously supported with venous-arterial extracorporeal membrane oxygenation (VA ECMO) and Impella®, as part of a staged plan for left ventricular assist device (LVAD) implantation and eventual heart transplantation. CASE PRESENTATION: A 51-year-old man presented with ST-elevation myocardial infarction complicated by cardiogenic shock requiring percutaneous coronary intervention with stenting, dual antiplatelet therapy, and combined VA ECMO-Impella® support. During workup for cardiac transplant, computed tomography (CT) staging revealed a 16-mm left renal mass suspicious for renal cell carcinoma. A multidisciplinary team prioritized definitive treatment to preserve transplant eligibility and elected RAPN under systemic heparinization alongside aspirin continuation (cangrelor briefly withheld). Therefore, RAPN was performed with 9 min of warm ischemia. The intraoperative course was hemodynamically stable. On postoperative day (POD) 4, late arterial bleeding from the resection bed was controlled by selective angioembolization. On POD 7, a durable LVAD was implanted as a bridge to heart transplantation. Final pathology showed pT1a, G2, R0 clear cell renal cell carcinoma. At 6 months, contrast-enhanced CT showed no recurrence and no major cardiovascular complications. CONCLUSIONS: RAPN during simultaneous ECMO and Impella® support is technically feasible with meticulous anticoagulation management, interventional radiology standby, and coordinated planning. This approach enables oncologic control while preserving a trajectory to transplant candidacy.
Evaluating pain management strategies following hypospadias repair: a survey of pediatric urologists.
Kaufmann J, Bouvette M, Qadar A … +3 more , Frimberger D, Rensing A, Meenakshi-Sundaram B
Can J Urol · 2026 Apr · PMID 42086361 · Publisher ↗
BACKGROUND: Pediatric opioid use has been associated with serious adverse effects, including persistent use and overdose. Recent studies have shown that opioid needs may be minimal following outpatient pediatric urologic...
BACKGROUND: Pediatric opioid use has been associated with serious adverse effects, including persistent use and overdose. Recent studies have shown that opioid needs may be minimal following outpatient pediatric urologic surgery. Post-operative pain regimens following pediatric penile surgery are not standardized. This study aimed to identify current opioid prescribing practices following hypospadias repair. METHODS: An online survey was administered to members of the Societies for Pediatric Urology, including eight questions surrounding physician demographics, hypospadias repair case volume, attitudes regarding opioid prescription in pediatric urology, and post-operative pain regimens. Responses were stratified for analysis. RESULTS: A total of 88 of 350 members responded to the survey, achieving a response rate of 25%. Most respondents practiced in an academic setting (73%) and had a case volume between 0-50 hypospadias repairs annually (76%). Only 26% of respondents reported using a standardized post-operative pain regimen following hypospadias repair. Respondents with higher case volumes were less likely to prescribe opioids. Following hypospadias repair, 61% of respondents reported regularly prescribing opioids, while 58% felt opioids are overprescribed following pediatric urologic procedures. CONCLUSIONS: This study demonstrates wide variability in opioid prescribing patterns and attitudes among pediatric urologists. Despite growing evidence that opioids may not be necessary following pediatric urologic surgery, over half of pediatric urologists regularly prescribe opioids following hypospadias repair. Additionally, over half of the respondents believe opioids are over-prescribed. These findings represent an opportunity to improve opioid stewardship, which is meaningful given the ongoing opioid crisis. This demonstrates the need for evidence-based pain management guidelines following hypospadias repair.
Observations of high variability in DNA fragmentation of epididymal sperm in men.
Kuchakulla M, Bhambhvani HP, Fisch R … +3 more , Ma R, Gal J, Goldstein M
Can J Urol · 2026 Apr · PMID 42086360 · Publisher ↗
OBJECTIVES: Men with obstructive azoospermia (OA) or infertility often require surgical sperm retrieval for assisted reproductive techniques. While sperm can be successfully obtained from either the testis or epididymis...
OBJECTIVES: Men with obstructive azoospermia (OA) or infertility often require surgical sperm retrieval for assisted reproductive techniques. While sperm can be successfully obtained from either the testis or epididymis in these patients, sperm DNA integrity may differ between retrieval sites, which could influence reproductive outcomes. This study aimed to determine whether bilateral epididymal and/or testicular sperm extraction is necessary in men with OA or infertility and elevated DNA fragmentation index (DFI). METHODS: We retrospectively analyzed men who underwent bilateral testicular biopsy and/or microscopic epididymal sperm aspiration (MESA) by a single surgeon from 2020-2022. TUNEL assays were performed to assess DFI (normal ≤15%). The primary endpoint of the study was to evaluate the variability in DFI between the right and left testes/epididymis in men undergoing sperm extraction. RESULTS: In total, 24 men met criteria to be included in this analysis who underwent sperm extraction with DFI analysis via MESA and/or testicular biopsy. Among patients with OA, testicular sperm demonstrated significantly lower DFI compared to epididymal sperm on both sides (right testis 9.52 vs. right epididymis 17.61, p = 0.01; left testis 9.22 vs. left epididymis 14.71, p = 0.04). For each individual patient with OA, the mean intra-patient difference in DFI between right and left epididymal sperm was significantly higher than the mean intra-patient difference in DFI between right and left testicular sperm (12.09% ± 6.58, compared to 2.27% ± 1.59, p < 0.001, respectively). CONCLUSION: Bilateral epididymal sperm extraction may be warranted in men with OA given the observed intra-patient variability in DNA fragmentation between epididymides. Conversely, bilateral testicular extraction may be unnecessary, as no significant difference in DNA fragmentation variability was observed between sperm retrieved from either testicle.
Barriers to urologic care following spinal cord injury.
Shilling MW, Fernandez SL, Ryan GJ … +4 more , Kim JG, Majure DC, Alba FM, Ehsanian R
Can J Urol · 2026 Apr · PMID 42086359 · Publisher ↗
BACKGROUND: Individuals with spinal cord injury (SCI) are at high risk for developing neurogenic bladder or neurogenic lower urinary tract dysfunction (NLUTD), which can lead to severe complications and negatively impact...
BACKGROUND: Individuals with spinal cord injury (SCI) are at high risk for developing neurogenic bladder or neurogenic lower urinary tract dysfunction (NLUTD), which can lead to severe complications and negatively impact quality of life. Despite the critical need for timely urologic care, barriers to access remain poorly understood, particularly in resource-limited settings. This study aims to identify systemic and perceived barriers to urologic follow-up for individuals with SCI treated at an academic medical center. METHODS: A single-center, observational study was conducted on individuals presenting with a diagnosis code indicative of complete SCI at an academic hospital between October 2015 and October 2023. Data were extracted from electronic medical records using ICD-10 codes for SCI, and phone interviews were conducted to assess symptoms, quality of life, and perceived barriers to care. Descriptive statistics summarized the findings. Univariate and multivariate Firth logistic regression analyses were performed to analyze for possible covariates impacting the odds of follow-up or having obtained a urodynamics study. RESULTS: Of 213 records, 136 met the inclusion criteria. Among them, only 17 (13%) received a urology consultation during their hospital stay, and 28 (21%) had been seen in a urology clinic post-injury. Phone interviews with 42 patients revealed that 93% reported NLUTD symptoms, with a mean quality of life impact score of 7.3. Barriers identified included availability (71%), accessibility (45%), accommodation (69%), affordability (43%), and acceptability (31%) barriers. Firth logistic regression demonstrated that male sex was associated with lower odds (OR = 0.205, 95% CI: 0.048, 0.772, p = 0.02) of having obtained a urodynamics study. CONCLUSION: Significant gaps in urologic care for individuals with SCI exist. Statistically significant variation in management via Firth logistic regression analyses also demonstrates potential disparities in follow-up and management. Addressing these challenges requires improved discharge planning, increased healthcare accessibility, and innovative care models such as telemedicine. Future research should explore broader geographic regions and interventions to improve outcomes.
A nutritional-inflammatory index for early prediction of inpatient urinary tract infection risk after acute stroke in the elderly.
Luo S, Xu H
Can J Urol · 2026 Apr · PMID 42086358 · Publisher ↗
BACKGROUND: Early detection and timely treatment of urinary tract infections (UTIs) can prevent the aggravation of the inflammatory response following a stroke and enhance the recovery of neurological function. This stud...
BACKGROUND: Early detection and timely treatment of urinary tract infections (UTIs) can prevent the aggravation of the inflammatory response following a stroke and enhance the recovery of neurological function. This study aimed to develop a simple scoring system by integrating nutritional and inflammatory markers to predict the occurrence of UTIs in patients with acute stroke. METHODS: Reviews of 1011 patients with acute stroke were retrieved. The Geriatric Nutritional Risk Index (GNRI) and systemic inflammation response index (SIRI) were utilized to develop a composite score of nutritional-systemic inflammation response index (G-SIRI). The primary endpoint was the efficacy of predicting stroke-associated UTIs through an area under the curve (AUC) using receiver operating characteristic analysis. Secondary outcomes included the optimal cut-off value, hazard ratio (HR), in-hospital mortality, and length of hospital stay. RESULTS: The composite scoring system of G-SIRI had a superior predictive accuracy for the occurrence of UTIs after acute stroke with a greater AUC of 0.850 (95% CI: 0.825-0.874) compared to either of isolated GNRI (0.782 [95% CI: 0.751-0.812]) or SIRI scores (0.796 [95% CI: 0.767-0.826]) (p < 0.001). A high-risk G-SIRI score was an independent predictor of stroke-associated UTI (HR = 2.192, 95% CI: 1.702-2.940) with a specificity of 0.784 and sensitivity of 0.899. A shorter survival time from post-stroke UTIs was observed in the high-risk G-SIRI cohort as opposed to the low-risk cohort (6.05 ± 1.14 vs. 3.22 ± 1.44 days, p < 0.001). The high-risk G-SIRI cohort showed significantly higher in-hospital mortality and longer length of hospital stays (all p < 0.05). CONCLUSIONS: The G-SIRI scoring system showed a superior efficacy in predicting stroke-associated UTIs as opposed to the individual GNRI or SIRI scores, which underscored the clinical utilization of integrating nutritional and inflammatory factors for UTI risk stratification among patients with acute stroke.
Association between the severity of acute renal colic episodes and clinical, laboratory, and imaging parameters.
Dang K, Cui T, Zhou Y … +4 more , Ji J, Yang Y, Wang X, Xiao J
Can J Urol · 2026 Apr · PMID 42086357 · Publisher ↗
OBJECTIVES: Although renal colic is a well-known acute manifestation of urolithiasis, the relationship between its pain severity and a range of clinical parameters has not been clearly established by comprehensive studie...
OBJECTIVES: Although renal colic is a well-known acute manifestation of urolithiasis, the relationship between its pain severity and a range of clinical parameters has not been clearly established by comprehensive studies. This study aimed to construct and validate a simple and accurate clinical nomogram for predicting the occurrence of more intense acute renal colic (ARC) in patients with urolithiasis. METHODS: The development and validation of the prediction model followed the reporting standards outlined in the TRIPOD checklist. A retrospective analysis was conducted on 285 patients who visited the Department of Urology at Beijing Friendship Hospital, Capital Medical University, from March 2024 to November 2024. Propensity score matching (PSM) of the raw observational data was conducted. This study utilized univariate, multivariate logistic, and linear regression analysis to screen and evaluate the risk factors for ARC pain intensity and constructed a predictive model. An evaluation was performed using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). RESULTS: Univariate analysis after PSM and linear logistic regression analysis identified independent risk factors for higher Visual Analog Scale (VAS) scores: serum creatinine (β-Coefficient = 0.364, 95% CI: 0.117-0.610, p = 0.005), pyuria (β-Coefficient = 0.273, 95% CI: 0.006-0.548, p = 0.042), hydronephrosis (β-Coefficient = 0.128, 95% CI: 0.073-0.254, p = 0.007), CRP levels (β-Coefficient = 0.311, 95% CI: 0.113-0.582, p = 0.018), and urinary bacteriuria ≥5/HPF (β-Coefficient = 0.324, 95% CI: 0.074-0.641, p = 0.018). The nomogram model demonstrated good accuracy with an AUC value of 0.964, and in the validation cohort, the AUC value was 0.969. The calibration curve indicated a better consistency between the predictive model and the actual occurrence of more intense ARC in patients with urolithiasis. The decision curve analysis showed favorable clinical utility. CONCLUSION: Serum creatinine, pyuria, hydronephrosis, CRP levels, and urinary bacteriuria ≥5/HPF are independent risk factors for higher VAS scores. The constructed predictive model based on these factors effectively assesses the risk of more intense ARC in patients with urolithiasis.
Genetic evidence against a causal relationship between myocardial infarction and urological malignancies.
Zhang W, Peng X
Can J Urol · 2026 Apr · PMID 42086356 · Publisher ↗
BACKGROUND: Observational studies have suggested potential associations between myocardial infarction (MI) and cancer risk, but the causal nature of these relationships remains unclear due to confounding factors and reve...
BACKGROUND: Observational studies have suggested potential associations between myocardial infarction (MI) and cancer risk, but the causal nature of these relationships remains unclear due to confounding factors and reverse causation. We aimed to investigate the bidirectional causal relationships between MI and urinary system cancers using genetic instruments. METHODS: We conducted a two-sample Mendelian randomization (MR) analysis using summary statistics from large-scale genome-wide association studies. Genetic variants associated with MI were used as instrumental variables (n = 19 SNPs for prostate cancer [PCa] and malignant neoplasm of kidney [MRN], n = 6 SNPs for bladder cancer, n = 21 SNPs for bladder cancer [BCa] validation). We examined the causal effects of MI on PCa, BCa, and MRN risk, as well as reverse causation. Multiple MR methods were employed, including inverse variance weighted (IVW), MR-Egger, weighted median, and weighted mode approaches. Both discovery and validation datasets were analyzed to ensure robustness. RESULTS: Forward MR analysis revealed no significant causal effect of MI on urinary system cancer risk across all examined malignancies. For PCa, the odds ratios (ORs) ranged from 0.964 to 1.007 across different methods and datasets (all p > 0.05). Similarly, MI showed no causal association with BCa risk (OR = 1.000, 95% CI: 0.999-1.002 in discovery cohort; OR = 1.000, 95% CI: 1.000-1.001 in validation cohort) or MRN risk (OR = 0.989-1.060 across methods in discovery cohort). Reverse MR analysis demonstrated no significant causal effects of PCa or kidney malignancy on MI risk, with ORs ranging from 0.250 to 1.200 (all p > 0.05). Sensitivity analyses confirmed the absence of pleiotropy and heterogeneity. CONCLUSION: Our genetic evidence does not support causal relationships between MI and urinary system cancers in either direction. The observed associations in epidemiological studies may be attributed to shared risk factors, treatment effects, or residual confounding rather than direct causal mechanisms. These findings have important implications for cancer surveillance strategies in MI patients and understanding cardio-oncology interactions.
Virtual basket mode in HoLEP: reduced early dysuria and faster continence recovery without loss of efficacy.
Özcan S, Dama M, Yorulmaz EM … +3 more , Köse O, Görgel SN, Akın Y
Can J Urol · 2026 Apr · PMID 42086355 · Publisher ↗
OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) is an established treatment for benign prostatic hyperplasia (BPH), but early postoperative dysuria and incontinence remain common concerns. The Virtual Baske...
OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) is an established treatment for benign prostatic hyperplasia (BPH), but early postoperative dysuria and incontinence remain common concerns. The Virtual Basket (VB) mode has been proposed to reduce tissue trauma. This study evaluated whether VB use improves early postoperative recovery without compromising HoLEP efficacy. METHODS: We retrospectively analyzed 168 men who underwent HoLEP between September 2023 and September 2024. Patients were categorized into three groups according to laser settings: 100 W Standard (n = 65), 100 W VB (n = 49), and 80 W VB (n = 54). The primary outcomes were postoperative dysuria and urinary incontinence at 1 and 3 months. Secondary outcomes included catheterization time, hemoglobin drop, surgical and energy efficiency, and perioperative complications. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify predictors of persistent incontinence. RESULTS: At 1 month, dysuria occurred more frequently in the Standard group (32.3%) than in the VB groups (15.6%) (p = 0.037). This difference was resolved within 3 months. Persistent urinary incontinence at 3 months was significantly lower in the VB groups (2.0% and 1.9%) compared with the Standard group (9.2%) (p = 0.031). Surgical efficiency was higher with Standard HoLEP (2.63 g/min vs. 1.8 g/min, p = 0.035), while energy efficiency was comparable across groups. The 100 W VB group had shorter catheterization times (p < 0.001) and less hemoglobin loss (p = 0.004). Logistic regression identified prostate volume as an independent predictor of incontinence (odds ratio [OR] = 1.018, 95% CI: 1.001-1.034, p = 0.035). ROC analysis demonstrated moderate predictive accuracy (area under curve [AUC] = 0.776). CONCLUSIONS: VB-HoLEP significantly reduces early dysuria and accelerates continence recovery while maintaining safety and efficacy. These findings support the routine use of VB mode to improve postoperative recovery and patient satisfaction.
Analysis of risk factors for MRI-invisible prostate cancer-the significance of AGGF1 immunohistochemical detection and PSAD.
Lyu J, Yue R, Tian Y … +1 more , Yang B
Can J Urol · 2026 Apr · PMID 42086354 · Publisher ↗
OBJECTIVES: Patients with a multi-parameter magnetic resonance imaging (mpMRI) prostate imaging report and data system (PI-RADS) score ≤ 3, but with clinically significant prostate cancer (CSPCa) detected by biopsy, are...
OBJECTIVES: Patients with a multi-parameter magnetic resonance imaging (mpMRI) prostate imaging report and data system (PI-RADS) score ≤ 3, but with clinically significant prostate cancer (CSPCa) detected by biopsy, are termed MRI-Invisible prostate cancer (MRI(-)PCa). This study aims to explore risk factors for MRI(-)PCa and identify immunohistochemical indicators with predictive significance. METHODS: A retrospective analysis was conducted on 376 patients with PI-RADS score ≤ 3 who underwent 24-needle systematic prostate biopsy at Beijing Friendship Hospital, Capital Medical University (January 2015 to October 2025). Clinical data, imaging data, and Angiogenic factor with G and FHA domain 1 (AGGF1) immunohistochemical results were collected. Patients were grouped into CSPCa (n = 102) and non-CSPCa (n = 274). t-tests, rank sum tests, and χ2 tests were used for univariate analysis, followed by multivariate Logistic regression to determine independent risk factors. Receiver Operating Characteristic (ROC) curves were drawn. Subgroup analyses were conducted based on prostate-specific antigen (PSA) status and PI-RADS score using the same statistical methods. Moreover, we also used the Kruskal-Wallis test to compare the differences in AGGF1 expression percentages across different Gleason score groups according to ISUP in CSPCa patients. RESULTS: Multivariate Logistic regression analysis showed that prostate-specific antigen density (PSAD) [OR: 0.971, 95%CI: 0.952, 0.991] and high expression of AGGF1 [OR: 1.065, 95%CI: 1.022, 1.109] were independent risk factors for MRI(-)PCa (p < 0.05). Meanwhile, when the PSAD of the patient is more than 0.25 ng/mL/cm3, it is necessary to be more suspicious that the patient may have prostate cancer (p < 0.05), and an AGGF1 immunohistochemical analysis should be conducted after the biopsy. In the PSA-negative subgroup, only high AGGF1 expression was an independent risk factor (p < 0.05). In the PSA-positive subgroup, PSAD [OR: 0.500, 95%CI: 0.279, 0.895] and AGGF1 [OR: 1.064, 95%CI: 1.037, 1.092] results were independent risk factors (p < 0.05). In subgroup analyses for PI-RADS 1-2 and PI-RADS 3, both PSAD and AGGF1 were accurate predictors of CSPCa (p < 0.05). Among all CSPCa patients, in the Gleason score 3 + 3 group, the average AGGF1 expression percentage of the patients was 48.60% ± 11.03%, which was significantly lower than that of the Gleason score 4 + 3 group (61.00% ± 6.12%) and the Gleason score 4 + 4 group (71.01% ± 4.46%), and the differences were statistically significant (p < 0.001). CONCLUSIONS: For patients with a PI-RADS score ≤ 3, attention should be paid to PSAD before biopsy, especially for those patients with PSAD > 0.25 ng/mL/cm3, not just PSA levels. After biopsy, AGGF1 immunohistochemical staining can be supplemented to help determine the risk and the malignancy of CSPCa.
Bladder cancer patients hospitalized in a medicine ward including three fuo cases following bacillus calmette-guérin immunotherapy.
Liatsos G, Zioutou K, Avramidis K … +3 more , Vamvakaris K, Potamiti-Komi M, Vassilopoulos D
Can J Urol · 2026 Apr · PMID 42086353 · Publisher ↗
OBJECTIVES: Bladder cancer (BC) is a prevalent malignancy with evolving treatment strategies and an increasingly aging patient population, resulting in a growing and complex burden of hospitalizations that extends beyond...
OBJECTIVES: Bladder cancer (BC) is a prevalent malignancy with evolving treatment strategies and an increasingly aging patient population, resulting in a growing and complex burden of hospitalizations that extends beyond urological care and remains insufficiently characterized in real-world Internal Medicine settings. This study aimed to analyze the clinical data and outcomes for patients with BC admitted to the medicine ward. Additionally, this research presents three cases of fever of unknown origin, which all exhibited identical clinical and laboratory findings but ultimately resulted in different disease diagnoses. METHODS: This retrospective case-series study included all adult patients with BC admitted to the Internal Medicine ward of a tertiary referral hospital between 1 January 2020, and 31 December 2024. Data acquisition was performed through a systematic search of electronic discharge records using the ICD-10 code C67. Data recording involved detailed review of electronic medical records to collect demographic characteristics, clinical history, cancer-related treatments, causes of hospitalization, and outcomes. Three patients previously treated with intravesical Bacillus Calmette-Guérin (iBCG) who presented with fever of unknown origin were analyzed in detail. Data analysis comprised descriptive statistics and comparative testing using Fisher's exact test and unpaired two-tailed Student's t-test, with p < 0.05 considered statistically significant. RESULTS: We identified 77 hospitalizations among 67 BC patients who were predominantly male, with a mean age of 75.2. A high prevalence of metabolic syndrome comorbidities and chronic obstructive pulmonary disease was documented. In addition, 31.1% of patients had metastatic BC, 22.9% had a second malignancy, 49.2% had undergone urological surgeries, and 38% had received chemotherapy or immunotherapy other than iBCG. The most common causes of hospitalization were infections, anemia/transfusions, a newly diagnosed metastatic disease, and acute renal failure. The mortality in this cohort was high (17%), with the leading cause of death again being an infection. Among patients who had previously received BCG immunotherapy, three cases of fever of unknown origin were noticed, and despite identical clinical settings, they were identified with different diseases [metastatic disease, infection caused by Bacillus Calmette-Guérin (BCGitis), and Hodgkin's lymphoma], necessitating individualized therapeutic medications. CONCLUSIONS: BC patients in the Internal Medicine unit are generally older adults, often dealing with several chronic conditions and a considerable cancer burden. They are predominantly admitted due to infections, which points to the urgent need for effective infection prevention strategies for this vulnerable population. When BC patients have a fever lasting more than seven days following BCG instillation, which is the maximum duration for self-limited adverse events to occur, regardless of whether an antibiotic regimen has been prescribed, they should consult an internal medicine department for further evaluation.
Genetic evidence for associations between food intake and prostatic diseases: a Mendelian randomization study.
Chen X, Ren C, Xie L … +1 more , Liu X
Can J Urol · 2026 Apr · PMID 42086352 · Publisher ↗
BACKGROUND: Regional differences in the incidence of prostate cancer (PCa) and prostatitis may be due to different food intake. But which foods affect PCa and prostatitis development or progression remains controversial....
BACKGROUND: Regional differences in the incidence of prostate cancer (PCa) and prostatitis may be due to different food intake. But which foods affect PCa and prostatitis development or progression remains controversial. This study aims to explore the causal relationship between PCa and prostatitis and 30 different foods using two-sample Mendelian randomization (MR) and multivariable MR (MVMR) analysis. METHODS: Data on 30 different foods were screened from the UK Biobank. PCa data came from a large meta-analysis of 140,254 individuals; prostatitis was obtained from the FinnGen consortium. The inverse variance weighted method was the main analysis method. MR-Egger, Cochran's Q, radial MR, and MR-PRESSO tests were used for sensitivity analysis. RESULTS: Our results demonstrated that never eating sugar [odds ratio (OR), 0.30; 95% confidence interval (CI), 0.11-0.80; p = 0.02] and never eating eggs (OR, 0.52; 95% CI, 0.28-0.97; p = 0.04) reduced the risk of PCa; raw vegetable intake (OR, 2.27; 95% CI, 1.01-5.09; p < 0.05) and dried fruit intake (OR, 1.38; 95% CI, 1.02-1.87; p = 0.04) increased PCa risk. And a negative correlation existed between processed meat intake and prostatitis (OR, 0.27; 95% CI, 0.08-0.94; p = 0.04). After adjusting for smoking and drinking, never eating sugar was negatively correlated with PCa, while the raw vegetable intake was positively correlated with the risk of PCa. CONCLUSION: Our study found four different foods associated with PCa and one food intake associated with prostatitis. We recommend more high-quality studies to reassess the benefits of individual foods in PCa.
Overweight status predicts improved overall survival after radical nephroureterectomy for upper tract urothelial carcinoma.
Wu SY, Li CC, Wu WJ … +28 more , Huang KH, Liu CL, Wang SS, Li JR, Weng HY, Tai TY, Chen PC, Cheong IS, Tsai CY, Cheng PY, Hong JH, Chen CH, Tseng JS, Lin WR, Jiang YH, Lee YK, Lin PH, Pang ST, Chen YT, Chen WC, Wu CC, Hsueh TY, Huang HC, Lin WY, Yu CC, Fang JK, Yu CC, Tsai YC
Can J Urol · 2026 Apr · PMID 42086351 · Publisher ↗
INTRODUCTION: Upper urinary tract urothelial carcinoma (UTUC) is a rare malignancy, particularly in the ureter, and is associated with high rates of recurrence and metastasis. Although body mass index (BMI) has been asso...
INTRODUCTION: Upper urinary tract urothelial carcinoma (UTUC) is a rare malignancy, particularly in the ureter, and is associated with high rates of recurrence and metastasis. Although body mass index (BMI) has been associated with prognosis in multiple cancer types, its role as a predictive factor in UTUC is still debated. This study aimed to investigate how BMI influences survival outcomes in patients with UTUC treated with radical nephroureterectomy (RNU). METHODS: This multi-center retrospective analysis by the Taiwan UTUC Collaboration Group involved 2503 patients who underwent treatment across 19 hospitals from 1988 to 2022. Patients were categorized into normal (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), and obese (BMI ≥ 27) groups. Demographic, clinical, and pathological data were analyzed. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS) were assessed using Kaplan-Meier analysis and Cox proportional hazards models. RESULTS: The median follow-up period was 44.2 months. In multivariable analysis, overweight patients demonstrated significantly better OS compared with normal-weight patients (p = 0.033), and the obesity group showed a favorable, though not statistically significant, trend toward better OS. However, BMI was not an independent predictor of CSS, DFS, or IVRFS. Independent predictors of worse outcomes included older age, end-stage renal disease, ureteral tumor location, tumor size ≥3 cm, and high-grade urothelial carcinoma. Tumor stage and grade were comparable across BMI groups. CONCLUSIONS: Overweight status was associated with better OS in patients with UTUC treated with RNU, while BMI had no significant impact on CSS, DFS, or IVRFS. These findings suggest a potential protective effect of higher BMI on OS, warranting further investigation in prospective studies. However, BMI alone should not guide clinical decisions and may instead reflect broader patient health characteristics.
Effectiveness and safety of external physical vibration lithecbole for upper urinary stone expulsion: a systematic review and meta-analysis.
Huang Y, Han B, Huang Z … +3 more , Huang Q, Wang T, Chen Y
Can J Urol · 2026 Apr · PMID 42086350 · Publisher ↗
OBJECTIVES: The external physical vibration lithecbole (EPVL) is a new device. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of hi...
OBJECTIVES: The external physical vibration lithecbole (EPVL) is a new device. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of high-level evidentiary support and a standard protocol. This study aimed to evaluate the effectiveness and safety of external physical vibration lithecbole (EPVL) as an adjunct to extracorporeal shock wave lithotripsy (ESWL) or retrograde intrarenal surgery (RIRS) for upper urinary tract stones. METHODS: We systematically searched PubMed, Web of Science, Embase, the China National Knowledge Infrastructure (CNKI), and the Cochrane Library from inception to 13 January 2026, for randomized controlled trials (RCTs) comparing EPVL plus standard care with standard care alone, and we pooled relative risks (RR) with 95% confidence intervals (CI). RESULTS: Nine RCTs involving 1418 patients were analyzed. Compared with standard care alone, EPVL significantly increased early stone-free rates at about 1 week (RR 1.44, 95% CI 1.18-1.77, p < 0.001) and 2 weeks (RR 1.40, 95% CI 1.20-1.63, p < 0.001) after ESWL or RIRS, with greater benefit for lower-pole (RR 1.56, 95% CI 1.25-1.96, p < 0.001) and renal pelvic stones (RR 1.54, 95% CI 1.10-2.14, p = 0.01). EPVL was associated with a lower rate of overall complications (RR 0.58, 95% CI 0.46-0.73, p < 0.001); specifically, it was linked to lower risks of hematuria (RR 0.64, 95% CI 0.48-0.86, p = 0.002) and urinary tract infection-related findings (RR 0.28, 95% CI 0.14-0.57, p < 0.001). CONCLUSIONS: Adjunctive EPVL improves short-term stone clearance after ESWL or RIRS without adding measurable risk and may also be associated with a reduced incidence of complications. Where available, EPVL can be considered as a non-invasive option to enhance fragment clearance, particularly for lower-pole renal stones. Further multicenter trials are needed to confirm long-term outcomes and generalizability. TRIAL REGISTRATION: PROSPERO CRD42024600537.
Can AI and predictive models accurately predict stone-free status? a systematic review and meta-analysis.
Ghazwani Y, Alghafees M, Alshasha M … +3 more , Brayan F, Alsayyari A, Alyami A
Can J Urol · 2026 Apr · PMID 42086349 · Publisher ↗
OBJECTIVES: The emergence of artificial intelligence (AI) and predictive modeling offers prospects for clinical, anatomical, and imaging factor combination, like radiomics, to help with stone-free status (SFS) estimation...
OBJECTIVES: The emergence of artificial intelligence (AI) and predictive modeling offers prospects for clinical, anatomical, and imaging factor combination, like radiomics, to help with stone-free status (SFS) estimation and peroperative decision-making. The goal of this study was, therefore, to define the present performance range, determine sources of heterogeneity, and determine methodological practices permitting reliable implementation by varied circumstances. METHODS: We searched six bibliographic databases through 19 September 2025. Studies deriving or validating AI/predictive models for SFS after ureteroscopy were eligible. Independent dual screening, duplicate data extraction, and risk-of-bias consideration using QUADAS-AI were conducted. RESULTS: Five retrospective cohorts were included. Modeling approaches encompassed multivariable logistic regression, regularized/radiomics pipelines, gradient boosting, and ensembles. SFS definitions ranged from <2 mm residual (day-1 to 3 months) to ≤5 mm residual (1 month), determined by plain radiography, ultrasound, and/or CT. The pooled ratio-scale effect for stone size per 1 mm increase was 1.26 (95% CI 0.91-1.76; τ² ≈ 0.055; Q = 18.52; I² = 94.6%; prediction interval 0.03-49.45). Hydronephrosis (moderate-severe vs. mild/none) showed a pooled RR 2.72 (95% CI 0.96-7.72; τ² ≈ 0.821; Q = 65.40; I² = 96.9%; prediction interval 0.03-249.87). As continuous contrasts, stone size was larger in the non-stone-free group (SMD 1.36, 95% CI 0.85-1.86; τ² ≈ 0.096; I² = 72.9%; prediction interval -3.77 to 6.48), and HU was higher (SMD 0.64, 95% CI 0.39-0.90; τ² ≈ 0; Q = 0.73; I² = 0%; prediction interval -0.99 to 2.27). CONCLUSIONS: Across studies evaluating AI and predictive models for ureteroscopy, discrimination was generally acceptable to excellent, and performance appeared highest in models integrating radiomics with anatomic/clinical descriptors. However, the degree of between-study heterogeneity (population mix, outcome definitions, imaging protocols, thresholds, and follow-up windows) was sufficiently large that pooled quantitative estimates should be considered clinically uninterpretable.
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