The Canadian Journal Of Urology[JOURNAL]
Sun
200 papers
Performance of fluorescence in situ hybridization in detecting lower versus upper tract urothelial carcinoma.
Xu S, Lu M, Yang Z … +1 more , Zheng H
Can J Urol · 2025 Dec · PMID 41496535 · Publisher ↗
BACKGROUND: Many studies have evaluated the performance of fluorescence in situ hybridization (FISH) in detecting urothelial carcinoma, while few of them compared it in detecting bladder cancer (BC) vs. upper tract uroth...
BACKGROUND: Many studies have evaluated the performance of fluorescence in situ hybridization (FISH) in detecting urothelial carcinoma, while few of them compared it in detecting bladder cancer (BC) vs. upper tract urothelial carcinoma (UTUC). This study aimed to determine and compare the FISH performance in detecting BC and UTUC. METHODS: Data of patients with suspected urothelial carcinoma (UC) who accepted FISH from January 2021 to April 2023 were retrieved. The sensitivity and specificity of FISH in detecting BC and UTUC were determined and compared. RESULTS: A total of 145 BC, 62 UTUC, and 170 non-UC patients were included. No significant differences existed between BC and UTUC cohorts in FISH sensitivity (46.2% vs. 51.6%, p = 0.476) and specificity (100% vs. 95.8%, p = 0.271). FISH sensitivity was significantly higher in high-grade vs. low-grade BC and increased gradually from Ta to ≥T2 group. It was also higher in patients with multiple or large tumors or older age. Similar tendencies were observed in UTUC. FISH sensitivity was higher in BC vs. UTUC in detecting T1 or ≥T2 tumors (p < 0.05). Multivariate analysis confirmed the tumor stage and the patient's age as predictors of FISH results in BC. CONCLUSIONS: FISH demonstrated overall similar sensitivity and specificity in detecting BC vs. UTUC, while the sensitivity was higher in BC for T1 or ≥T2 tumors. FISH was more sensitive in detecting more invasive or advanced tumors. The tumor stage and the patient's age were predictors of the FISH result in BC.
Modern diagnostics: ultrasound elastography and magnetic resonance imaging in initial evaluation of testicular cancer.
Arik ŞB, Güvenç İ
Can J Urol · 2025 Dec · PMID 41496534 · Publisher ↗
OBJECTIVES: Differentiating benign from malignant testicular lesions is essential to avoid unnecessary surgery and ensure timely intervention. While conventional ultrasound remains the first-line imaging method, elastogr...
OBJECTIVES: Differentiating benign from malignant testicular lesions is essential to avoid unnecessary surgery and ensure timely intervention. While conventional ultrasound remains the first-line imaging method, elastography and MRI provide additional functional and structural information. This study assesses the diagnostic utility of testicular elastography and magnetic resonance imaging (MRI) in differentiating benign and malignant testicular lesions. METHODS: Patients with sonographically detected testicular masses were retrospectively evaluated using elastography, scrotal MRI, and tumor markers. Quantitative and qualitative imaging findings, lesion size, and laboratory values were recorded. Statistical analyses included Fisher's exact test, logistic regression, Receiver operating characteristic (ROC) analysis, and machine learning classification using the eXtreme Gradient Boosting (XGBoost) model. RESULTS: Our analysis demonstrated that quantitative elastography significantly predicts malignancy (p = 0.042), with high diagnostic power (Area under the Curve [AUC] = 0.91). Additionally, Doppler ultrasound vascularity showed a statistically significant positive correlation with malignancy risk (p = 0.0033), highlighting its value in diagnosis. In contrast, qualitative elastography and MRI contrast enhancement lacked statistical significance. MRI diffusion restriction provided valuable insight into malignancy risk, though the latter did not reach statistical significance. An XGBoost model incorporating imaging and laboratory parameters showed high precision in detecting malignancies (85.7%). CONCLUSION: Findings underscore the importance of Doppler ultrasound as the primary diagnostic tool, with elastography and diffusion MRI aiding in cases of diagnostic ambiguity. The combined use of all imaging modalities and laboratory markers enhances diagnostic accuracy in evaluating testicular masses.
Adverse histological features are more commonly observed in hypergonadotropic prostate cancer patients.
Shatylko T, Safiullin R, Gamidov S … +5 more , Ivanets T, Mammaev R, Guluzade K, Rodin I, Sukhikh G
Can J Urol · 2025 Dec · PMID 41496533 · Publisher ↗
BACKGROUND: Some patients with prostate cancer have elevated gonadotropin levels. It is unknown, however, whether this condition directly influences carcinogenesis in the prostate. It is also unknown whether any specific...
BACKGROUND: Some patients with prostate cancer have elevated gonadotropin levels. It is unknown, however, whether this condition directly influences carcinogenesis in the prostate. It is also unknown whether any specific hormone levels are useful to predict aggressive disease. The potential role of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in prostate physiology is widely discussed. The study aimed to evaluate whether patients with this endocrine pattern have different outcomes following radical prostatectomy. METHODS: This was a prospective cohort study of consecutive patients undergoing robot-assisted radical prostatectomy at the Andrology and Urology Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov (Moscow) from September to December 2023. After applying exclusion criteria, 60 patients were included and stratified into a hypergonadotropic cohort (upper tertile for LH and FSH; n = 14) and a control cohort (n = 46). Primary outcome was adverse histology defined as ISUP grade ≥ 3 on final pathology. RESULTS: 10 of 14 hypergonadotropic patients (71.4%) and 15 of 46 patients in the control cohort (32.6%) had ISUP grade ≥ 3, and this difference was statistically significant (p = 0.014). The rate of T3 disease on pathology was 42.9% and 32.6% in hypergonadotropic patients and the control cohort, respectively (p = 0.532). No significant correlation was found between PSA and gonadotropin levels. CONCLUSIONS: Patients with prostate cancer may have elevated gonadotropin levels, potentially predicting aggressive disease. If validated, these findings could influence clinical decision-making in prostate cancer based on LH and FSH levels.
Green is the new gold: a systematic review of the environmental impact of urological procedures, telehealth, and conferences.
Hordines J, Ge S, Raskolnikov D … +2 more , Small AC, Watts KL
Can J Urol · 2025 Dec · PMID 41496532 · Publisher ↗
BACKGROUND: The healthcare industry contributes nearly 5% of worldwide carbon emissions. In an effort to mitigate this impact, urology practices can take steps to reduce their carbon footprints. We conducted a systematic...
BACKGROUND: The healthcare industry contributes nearly 5% of worldwide carbon emissions. In an effort to mitigate this impact, urology practices can take steps to reduce their carbon footprints. We conducted a systematic review which aimed to summarise the current literature on the environmental impact of urologic-related care. METHODS: A systematic literature review evaluating the impact of urologic procedures, telehealth and conferences/interviews was conducted on PubMed and Cochrane databases using a Boolean search strategy and the following search terms: urology, planetary health, environmental impact, carbon emissions, carbon footprint, and waste. Full-text articles published in English were included and reviewed by two independent reviewers. The studies were grouped into three categories: surgical/procedural, telehealth, and conference/interview travel. RESULTS: The initial search yielded 318 studies, of which 62 full-text manuscripts were reviewed. Of these, 22 studies met criteria for our systematic review: 13 surgical/procedural, 5 telehealth, 4 conference/interview travel. Most surgical/procedural studies compared the carbon footprint of flexible cystoscopy vs. disposable cystoscopy and found that disposable cystoscopy had a favourable environmental impact. The telehealth and conference/interview articles concluded that virtual settings significantly reduced environmental impact. CONCLUSIONS: An increasing body of literature has evaluated the impact of urologic care on planetary health and demonstrated opportunities to minimise our carbon footprint. Incorporating changes to common procedures and considering virtual formats for clinics, conferences, and interviews-even in part-confers environmental benefits. Efforts to adopt greener and more sustainable practices in urology are necessary to mitigate the threat to planetary health.
Patient reported outcome measures: their evolution and expansion in urology.
Maremanda AP, Faris A, Breyer BN
Can J Urol · 2025 Dec · PMID 41496531 · Publisher ↗
We describe the history of Patient-Reported Outcome Measures (PROMs) in medicine, with a focus on the development and use of the International Index of Erectile Function (IIEF) in urologic practice. PROMs emerged in the...
We describe the history of Patient-Reported Outcome Measures (PROMs) in medicine, with a focus on the development and use of the International Index of Erectile Function (IIEF) in urologic practice. PROMs emerged in the 1970s with tools like the Sickness Impact Profile, designed to capture patients' perspectives on how disease affects daily life. In the 1990s, PROMs entered urology with the creation of the International Prostate Symptom Score (IPSS) and the IIEF, developed in 1992 and 1997, respectively. As organizations such as the National Institutes of Health began prioritizing PROMs for evaluating sexual function, the IIEF gained recognition as a valid and reliable measure of erectile dysfunction severity. The introduction of the abbreviated IIEF-5 further expanded its use in both research and clinical practice. For this review, we searched PubMed for literature on the history, development, and application of PROMs and the IIEF, and conducted an oral interview with Dr. Raymond C. Rosen, the IIEF's primary author. In conclusion, PROMs have long served as essential tools for capturing patients' experiences, and the IIEF has significantly advanced sexual medicine by offering a highly valid and reliable instrument for assessing erectile dysfunction.
Correlation between chronic prostate inflammation and overactive bladder symptoms following transurethral resection of the prostate due to benign prostate hyperplasia.
Aydogdu O, Erdemoglu O, Bozkurt HI … +2 more , Degirmenci T, Winder M
Can J Urol · 2025 Oct · PMID 41220364 · Publisher ↗
OBJECTIVES: Treatment of patients with lower urinary tract symptoms (LUTS) is often challenging. In men, the origin of LUTS, in particular overactive bladder (OAB) symptoms, is often due to prostate enlargement. However,...
OBJECTIVES: Treatment of patients with lower urinary tract symptoms (LUTS) is often challenging. In men, the origin of LUTS, in particular overactive bladder (OAB) symptoms, is often due to prostate enlargement. However, patients with chronic prostate inflammation (CPI) also frequently experience OAB. Thus far, it is not known if the inflammation per se or concomitant prostate enlargement is the underlying cause of LUTS. Currently, we aim to examine if there is any correlation between CPI and the persistence of OAB symptoms in patients with benign prostate hyperplasia (BPH). METHODS: Fifty-one men underwent transurethral resection of the prostate (TUR-P). Based on pathological examination, the patients were divided into two groups, i.e., those with and without prostate inflammation. All patients were examinedwith the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), international prostate symptom score (IPSS) and overactive bladder questionnaire validated-8 (OAB-V8) both pre-and post-operatively. Further, all patients were clinically examined through urine culture, prostate-specific antigen (PSA), uroflowmetry, postvoiding residual urine volume (PVR), and ultrasound of the prostate and bladder. RESULTS: None of the clinical examinations showed significant differences between the two groups. By questionnaire analysis, both groups showed similar significantly improved NIH-CPSI and IPSS scores after TUR-P. However, OAB symptoms were only significantly improved in patients without CPI. CONCLUSIONS: Even though TUR-P improves many of the LUT symptoms in patients with BPH, OAB symptoms with concomitant CPI are more challenging to manage. Identifying concomitant CPI in men with BPH can potentially help to guide post-operative decision-making following TUR-P.
Spermatocelectomy with and without epididymectomy: retrospective experience at a single institution in patients not interested in fertility preservation.
Cahill EM, Choksi AU, Reddy SS … +3 more , Heckscher DCH, Rotker K, Honig SC
Can J Urol · 2025 Oct · PMID 41220363 · Publisher ↗
INTRODUCTION: Spermatocelectomy is a surgical procedure performed for symptomatic spermatoceles. Published data is limited with respect to recurrence rates, complication rates, and patient satisfaction. The core concept...
INTRODUCTION: Spermatocelectomy is a surgical procedure performed for symptomatic spermatoceles. Published data is limited with respect to recurrence rates, complication rates, and patient satisfaction. The core concept of spermatocelectomy is to identify the communication between epididymis and spermatocele, which can be difficult and may result in spermatocele recurrence. We postulate that a combined spermatocelectomy with epididymectomy will yield a lower rate of recurrence. METHODS: A retrospective chart review of patients with symptomatic spermatoceles undergoing spermatocelectomy with or without epididymectomy at our institution was performed. Patients were excluded from epididymectomy if they were interested in fertility preservation. Patient demographics, operative characteristics, and rates of recurrence and re-intervention were collected. RESULTS: From 2013 to 2023, 70 patients underwent spermatocelectomy from a total of 14 surgeons, 35 (50%) of which underwent concurrent epididymectomy. A total of 10 (14.3%) patients experienced a recurrence and 5 (7.1%) patients required re-intervention with aspiration or re-excision over a median follow-up of 3.5 months. Patients who underwent spermatocelectomy alone were significantly more likely to experience recurrence (p = 0.006). CONCLUSION: Current data is lacking regarding recurrence rates after spermatocelectomy. Spermatocelectomy with epididymectomy resulted in a lower recurrence rate than spermatocelectomy alone. Removing the source of the communication between spermatocele and epididymis may result in a lower recurrence rate. A prospective, randomized trial is recommended to confirm these findings.
Spontaneous rupture of the urinary bladder after pelvic angioembolization: high clinical suspicious for prompt diagnosis is the key.
Mercedes R, Eidelman E, Mawhorter M … +2 more , Yudovich M, Aminsharifi A
Can J Urol · 2025 Oct · PMID 41220362 · Publisher ↗
BACKGROUND: Spontaneous rupture of the urinary bladder (SRUB) is a rare condition characterized by bladder rupture without any trauma or previous instrumentation. Diagnosing SRUB can be challenging, leading to potential...
BACKGROUND: Spontaneous rupture of the urinary bladder (SRUB) is a rare condition characterized by bladder rupture without any trauma or previous instrumentation. Diagnosing SRUB can be challenging, leading to potential delays in treatment and significant morbidity. CASE DESCRIPTION: We present a case of a 75-year-old male with a complex medical history, including atrial fibrillation, systemic lupus erythematosus, antiphospholipid syndrome, and chronic anticoagulation, who developed sudden onset gross hematuria and abdominal pain following bilateral internal iliac artery angioembolization for a spontaneous pelvic hematoma in the setting of supratherapeutic anticoagulation. Extraperitoneal bladder perforation was confirmed by CT cystogram. Conservative management failed, and bladder exploration confirmed a friable, ischemic bladder wall defect. Bladder repair was performed with reinforcement using an absorbable fibrin sealant patch. Follow-up imaging demonstrated gradual resolution of urine extravasation, and the patient ultimately regained spontaneous voiding after catheter removal. CONCLUSIONS: This report underscores the importance of high clinical suspicion for SRUB in patients with pelvic ischemic insults, particularly after angioembolization. Although rarely reported in the literature, bladder rupture may represent a potential complication in this setting. Early imaging and surgical intervention are critical for favorable outcomes. Clinicians should consider ischemia-related SRUB in differential diagnoses to reduce diagnostic delays and optimize management strategies.
Primary renal aspergilloma: a challenge to endure-a case report.
Mohapatra S, Madhekar N, Ratkal S … +1 more , Ratkal J
Can J Urol · 2025 Oct · PMID 41220361 · Publisher ↗
BACKGROUND: Isolated renal aspergilloma is a rare medical entity posing difficult diagnostic and treatment challenges. CASE DESCRIPTION: We document a case of Primary Renal Aspergilloma in a 55-year-old male with diabete...
BACKGROUND: Isolated renal aspergilloma is a rare medical entity posing difficult diagnostic and treatment challenges. CASE DESCRIPTION: We document a case of Primary Renal Aspergilloma in a 55-year-old male with diabetes mellitus, hypertension, and chronic liver disease. The individual presented with features of obstructive uropathy due to fungal balls requiring retrograde endoscopic intervention and drainage. The cheesy material retrieved during the procedure was identified as an Aspergilloma on histopathology. Due to far and fewer reports in the medical literature, there have been no standard diagnostic & management strategies, which in turn has resulted in unacceptably high mortality. CONCLUSION: Isolated renal aspergilloma is an uncommon medical condition with intricate diagnostic and treatment pathways. Due to the rarity of the disease, there is no established protocol for the treatment of renal aspergillomas. Further research is necessary to improve diagnostics, optimize treatments, and enhance clinician awareness for early detection and management.
A case report of epithelioid renal angiomyolipoma with inferior vena cava extension: robotic surgical management and literature review of rare presentation.
Karki D, Yaakoubi G, Edelblute B … +1 more , Aboumohamed A
Can J Urol · 2025 Oct · PMID 41220360 · Publisher ↗
BACKGROUND: Epithelioid angiomyolipoma (EAML) is an uncommon renal tumor variant with histologic and radiologic features that can mimic renal cell carcinoma (RCC) on imaging due to the paucity of fat compared to the clas...
BACKGROUND: Epithelioid angiomyolipoma (EAML) is an uncommon renal tumor variant with histologic and radiologic features that can mimic renal cell carcinoma (RCC) on imaging due to the paucity of fat compared to the classic AML. EAML may exhibit aggressive behavior, including local invasion, recurrence, and distant metastases to the liver, lungs, and lymph nodes. Although recent reports suggest that up to one-third of EAML cases may behave malignantly, variability in diagnostic criteria and limited case series contribute to uncertainty regarding its true clinical course. CASE DESCRIPTION: This case report describes a 19-year-old female presenting with an 11.9 cm right renal EAML with a tumor thrombus extending into the inferior vena cava (IVC). She underwent a robotic radical nephrectomy with IVC thrombectomy and lymph node dissection. The final pathology revealed EAML with negative margins. Follow-up computed tomography (CT) imaging demonstrated no recurrence of disease/metastasis. The rarity of this presentation and the lack of consensus on management highlight the importance of reporting such cases. CONCLUSIONS: This rare case of EAML with IVC tumor thrombus demonstrates that timely robotic surgical intervention with appropriate follow-up is critical for the appropriate management of renal EAML.
Tranexamic acid and hematuria outcomes following aquablation for benign prostatic hyperplasia.
Taboada P, Badia RR, Advano D … +7 more , Murphy A, Sze C, Mauck RJ, Tse J, Gahan J, Roehrborn CG, Goueli R
Can J Urol · 2025 Oct · PMID 41220359 · Publisher ↗
BACKGROUND: Aquablation is a robotic-assisted, water jet-based transurethral therapy for benign prostatic hyperplasia (BPH). Concerns about postoperative hematuria led to the practice of limited transurethral resection (...
BACKGROUND: Aquablation is a robotic-assisted, water jet-based transurethral therapy for benign prostatic hyperplasia (BPH). Concerns about postoperative hematuria led to the practice of limited transurethral resection (TUR) with cauterization. This study aimed to assess the impact of tranexamic acid (TXA) on hematuria outcomes when combined with limited TUR after Aquablation. METHODS: We retrospectively analyzed men undergoing Aquablation at our institution (October 2020-July 2024). Demographic, prostate, surgical, and hematuria outcomes were extracted from electronic medical records. Kruskal-Wallis test compared medians. RESULTS: Of 131 patients, 113 (86%) had limited TUR; 31 (27%) received 1 g TXA perioperatively. TXA patients had larger prostates (86 g vs. 70 g, p = 0.003). No TUR patients, with or without TXA, required transfusion. Among TUR patients, TXA did not significantly affect preoperative, postoperative, or postoperative day-one hemoglobin. Patient-initiated communications and emergency visits for hematuria were minimal and similar between groups. Hematuria outcomes were independent of prostate size, TUR volume, or TUR-to-prostate ratio. Subgroup analysis (<80 g vs. ≥80 g) showed no TXA effect. No TXA recipient had a thromboembolic event within 30 days. At one month, median urinary flow increased by 12.8 mL/sec interquartile range [IQR]: 8.7-18.8, and median International Prostate Symptom Score (IPSS) decreased by 7 (IQR: 3-12). CONCLUSIONS: Limited TUR during Aquablation provides effective hemostasis. TXA had minimal impact on bleeding and was not associated with thromboembolic events. Routine TXA use should be reconsidered when limited TUR is performed.
A prospective randomized trial comparing dusting and fragmentation techniques using Holmium:YAG laser for pediatric ureteral stones.
Ahmed A, Farhan B, Alam-Eldin A … +5 more , Helmy MA, Hussein MM, Mohamed Z, Gad HA, Vodnala SN
Can J Urol · 2025 Oct · PMID 41220358 · Publisher ↗
BACKGROUND: As occurrence rates of pediatric ureteral stones have increased, evaluation of optimal treatment modalities has become imperative. This study's primary goal is to compare outcomes between dusting and fragment...
BACKGROUND: As occurrence rates of pediatric ureteral stones have increased, evaluation of optimal treatment modalities has become imperative. This study's primary goal is to compare outcomes between dusting and fragmentation techniques using Holmium:YAG (Ho:YAG) laser lithotripsy in children with ureteral stones. METHODS: A prospective randomized study was conducted at Aswan University Hospitals from June 2023 to December 2024. One hundred children, under the age of 18, with single, mid- or distal, ureteral stones (5-20 mm) were randomized into two groups. Group A received laser dusting (0.2-0.6 J, 20-40 Hz), while Group B received fragmentation (0.8-1.5 J, 10-15 Hz), both using a 200-μm fiber. Stone-free rate (SFR), operative time, complications, and other outcomes were evaluated. RESULTS: Demographics, laboratory parameters, stone size, and location were similar across groups. Group B had a significantly longer operative time but demonstrated a higher SFR (86% vs. 66%). Basket use was universal in the fragmentation Group (B) and was the only independent predictor of stone-free status (p = 0.035). Rates of complication, retreatment, and ureteral injury did not differ significantly between the two groups. CONCLUSIONS: While both techniques are safe and effective in pediatric ureteroscopic lithotripsy, fragmentation achieves a higher SFR at the cost of longer operative time and mandatory basket use. As the dusting setting offers shorter procedure times, both settings may be suitable for selected cases depending on clinical factors such as septic status.
Freehand transperineal prostate biopsy under local anesthesia using a novel needle guide system with angle-adjustment feature.
Özden E, Öztürk E
Can J Urol · 2025 Oct · PMID 41220357 · Publisher ↗
OVERVIEW: Freehand transperineal prostate biopsy (TPPB) needle guides are designed to maintain a parallel alignment between the co-axial introducer needle and the ultrasound (US) transducer. However, this parallel alignm...
OVERVIEW: Freehand transperineal prostate biopsy (TPPB) needle guides are designed to maintain a parallel alignment between the co-axial introducer needle and the ultrasound (US) transducer. However, this parallel alignment necessitates transducer angulations within the patient's rectum for sampling anterior or posterior regions of the prostate, which introduces several problems both for the patient and the operator. This article introduces a technique using a TPPB needle guide system with a novel angle-adjustment feature, which minimizes intrarectal transducer movements. OBJECTIVES: Freehand TPPB typically requires anterior or posterior angulation of the ultrasound (US) transducer, which leads to prostate compression, increased patient discomfort, reduced sonographic image quality, and challenges in MRI-ultrasound fusion biopsy registration. To address these issues, a novel TPPB needle guide system (PERINO-FLEX) featuring a co-axial needle angle adjustment mechanism has been introduced. The system includes a rotating component through which the coaxial needle passes, enabling up to 45 degrees of anterior or posterior angulation within the perineum, without the need to angulate the intrarectal US transducer. In this article, we aim to describe the TPPB technique utilizing this unique angle-adjustment feature and to highlight its advantages.
Single port robotic partial nephrectomy via a retroperitoneal approach.
Leong JY, Prasad V, Perez Kerkvliet CJ … +3 more , Wagner AA, Link RE, Shah MS
Can J Urol · 2025 Oct · PMID 41220356 · Publisher ↗
In recent years, the introduction of the Da Vinci Single Port (SP) robotic platform has opened new doors for the treatment of localized renal masses. This technology, particularly when utilized via a regionalized retrope...
In recent years, the introduction of the Da Vinci Single Port (SP) robotic platform has opened new doors for the treatment of localized renal masses. This technology, particularly when utilized via a regionalized retroperitoneal (RP) approach, offers several distinct advantages that may improve patient recovery. These advantages include easier access to both anterior and posterior renal tumors, avoidance of the peritoneal cavity with complicating adhesions, and simplified supine positioning, potentially reducing the risk of musculoskeletal or nerve injuries. Yet, the learning curve for RP surgery remains steep due to the unfamiliarity of many surgeons with the RP endoscopic perspective and ergonomic challenges of the SP robot. Given this relatively new technology and its growing availability in many institutions, most surgeons remain early in their evolution of performing SP partial nephrectomy (PN). Herein, we discuss our technique for performing SP PN via an RP approach, including port access, anatomic considerations, and operative techniques. Our hope is to familiarize readers with this powerful approach and smooth out early pitfalls during the learning curve.
Associations of systemic immune-inflammation index, product of platelet, and neutrophil count, with the pathological grade of bladder cancer.
Zhang L, Cao L, Huang L … +2 more , Wang J, Li J
Can J Urol · 2025 Oct · PMID 41220355 · Publisher ↗
BACKGROUND: Studies have indicated an association between inflammatory factors (IFs) in the blood and the development of bladder cancer (BC). This study aimed to explore the correlation and clinical significance of IFs w...
BACKGROUND: Studies have indicated an association between inflammatory factors (IFs) in the blood and the development of bladder cancer (BC). This study aimed to explore the correlation and clinical significance of IFs with the pathological grading of BC. METHODS: A retrospective analysis was conducted on the preoperative blood routine results, postoperative pathological findings, and baseline information of 163 patients. Patients were divided into high-grade and low-grade groups based on pathological grading. Group comparisons and logistic regression analyses were performed using R software version 4.1.3 to explore the relationships between IFs and BC pathological grading. RESULTS: The results indicated that platelet count, lymphocyte count, neutrophil count, body mass index (BMI), smoking, drinking, and hypertension (all p < 0.05) were associated with BC pathological grading. The logistic regression model revealed that higher levels of IFs in the blood were associated with a higher probability of high-grade BC tumors (ln-SII, odds ratio [OR]: 2.95, 95% CI: 1.43, 6.38, p = 0.004; ln-PPN, OR: 16.02, 95% CI: 6.37, 47.02, p < 0.001), suggesting a correlation between IFs in the blood and BC pathological grading. Additionally, group comparisons showed that the values of systemic immune inflammation index (SII) and product of platelet and neutrophil count (PPN) were significantly higher in the high-grade BC group than in the low-grade BC group (p < 0.05). CONCLUSIONS: IFs have predictive value for BC pathological grading, providing a theoretical basis for clinical diagnosis and treatment.
AI-based detection of MRI-invisible prostate cancer with nnU-Net.
Lyu J, Yue R, Yang B … +2 more , Li X, Song J
Can J Urol · 2025 Oct · PMID 41220354 · Publisher ↗
OBJECTIVES: This study aimed to develop an artificial intelligence (AI)-based image recognition system using the nnU-Net adaptive neural network to assist clinicians in detecting magnetic resonance imaging (MRI)-invisibl...
OBJECTIVES: This study aimed to develop an artificial intelligence (AI)-based image recognition system using the nnU-Net adaptive neural network to assist clinicians in detecting magnetic resonance imaging (MRI)-invisible prostate cancer. The motivation stems from the diagnostic challenges, especially when MRI findings are inconclusive (Prostate Imaging Reporting and Data System [PI-RADS] score ≤ 3). METHODS: We retrospectively included 150 patients who underwent systematic prostate biopsy at Beijing Friendship Hospital between January 2013 and January 2023. All were pathologically confirmed to have clinically significant prostate cancer, despite negative findings on preoperative MRI. A total of 1475 MRI images, including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) sequences, were collected. The nnU-Net was employed as the initial segmentation framework to delineate tumor regions in MRI images, based on histopathologically confirmed prostate cancer sites. A convolutional neural network-based deep learning model was subsequently designed and trained. Its performance was evaluated using five-fold cross-validation. RESULTS: Among 150 patients with clinically significant prostate cancer diagnosed, all with PI-RADS ≤ 3 on MRI, the median age was 67 years (IQR: 62-72), and 105 patients (70.0%) had a Gleason score ≥ 7. A total of 1475 multiparametric MRI images were analyzed. Using five-fold cross-validation, the AI-based image recognition system achieved a mean Dice similarity coefficient of 55.0% (range: 51.6-56.5%), with a mean sensitivity of 50.5% and a mean specificity of 96.9%. The corresponding mean false-positive and false-negative rates were 3.1% and 49.5%, respectively. CONCLUSION: We successfully developed an AI-based image recognition system utilizing the nnU-Net adaptive neural network, demonstrating promising diagnostic performance in detecting MRI-invisible prostate cancer. This system has the potential to enhance early detection and management of prostate cancer.
AI-driven radiogenomic analysis of clear cell renal cell carcinoma: perinephric adipose tissue stranding as a key feature of the NIPAL4-associated imaging pattern.
Greco F, Cataldo M, D'Andrea V … +5 more , Pugliese L, Panunzio A, Tafuri A, Zobel BB, Mallio CA
Can J Urol · 2025 Oct · PMID 41220353 · Publisher ↗
BACKGROUND: Radiogenomics offers a non-invasive approach to correlate imaging features with tumor molecular profiles. This study aims to identify computed tomography (CT) imaging characteristics associated with positive...
BACKGROUND: Radiogenomics offers a non-invasive approach to correlate imaging features with tumor molecular profiles. This study aims to identify computed tomography (CT) imaging characteristics associated with positive NIPA-like domain containing 4 (NIPAL4) expression in clear cell renal cell carcinoma (ccRCC) and to develop a radiogenomic predictive model to support personalized risk stratification. METHODS: A retrospective analysis was conducted on 241 ccRCC patients from The Cancer Genome Atlas (TCGA) and The Cancer Imaging Archive (TCIA) databases. Clinical, pathological, and CT features were compared between NIPAL4-positive and NIPAL4-negative groups. A penalized logistic regression model was built to predict NIPAL4 expression, and its performance was assessed using Receiver Operating Characteristic (ROC) and Decision Curve Analysis (DCA). Additionally, unsupervised K-means clustering was used to identify radiologic phenotypes, and a nomogram was developed to enable individualized risk estimation. RESULTS: Among 241 ccRCC patients, 29 (12.03%) showed positive NIPAL4 expression. Compared to NIPAL4-negative cases, positive expression was significantly associated with larger tumor size (median 70.5 mm vs. 52 mm, p = 0.0371), ill-defined margins (61.5% vs. 32.4%, p = 0.0077), perinephric adipose tissue stranding (76.9% vs. 50.0%, p = 0.0114), renal vein thrombosis (24.0% vs. 4.7%, p = 0.021), Gerota's fascia thickening (61.5% vs. 35.2%, p = 0.0163), and collecting system invasion (52.0% vs. 26.5%, p = 0.0171). A multivariate penalized logistic regression model incorporating these features achieved an AUC of 0.973% and 92.1% accuracy in predicting NIPAL4 positivity. CONCLUSIONS: Positive NIPAL4 expression in ccRCC is significantly associated with aggressive CT features-particularly perinephric adipose tissue stranding, ill-defined margins, and renal vein thrombosis. A radiogenomic model based on these features achieved excellent predictive performance (AUC = 0.973), supporting its potential role in non-invasive risk stratification and personalized clinical decision-making.
Cryotherapy for non-muscle invasive bladder cancer-preliminary results in an animal model.
Hoffman A, Kochavi E, Amiel GE
Can J Urol · 2025 Oct · PMID 41220352 · Publisher ↗
OBJECTIVES: Initial treatment for Non-Muscle Invasive Bladder Cancer (NMIBC) has remained mostly unchanged in recent decades. Cryotherapy with CO2 has been commonly used in medicine for many years. In this study, we pres...
OBJECTIVES: Initial treatment for Non-Muscle Invasive Bladder Cancer (NMIBC) has remained mostly unchanged in recent decades. Cryotherapy with CO2 has been commonly used in medicine for many years. In this study, we present the results of a pre-clinical study aimed at developing a novel cryoablation device to treat superficial low-grade bladder lesions. METHODS: Following initial technical and developmental studies, a rigid cryotherapy device was developed. A technical and efficacy assessment was conducted utilizing the porcine model. Overall, twenty-six ablation areas (up to four per animal) were evaluated. Following an initial routine cystoscopy, the bladder irrigation medium was replaced with CO2 insufflation, and each area was treated with 2 cycles (15 s each) of direct liquid CO2 spraying. After five days, the bladder epithelium was harvested for pathological evaluation. RESULTS: No bladder perforation was noted on pathology. The initial efficacy and usability of the device were demonstrated. Pathological evaluation of treated tissue morphology revealed focal mucosal edema and necrosis with associated surrounding reactive fibrosis, with penetration depths ranging from 0.5 to 4 mm, without profound muscularis propria damage. CONCLUSIONS: Initial results suggest the safety and feasibility of cryotherapy utilizing CO2 spraying. Pathological analysis confirms its potential in treating non-muscle invasive bladder cancer. Ongoing clinical studies aim to validate these results in human subjects, offering a potential paradigm shift in non-muscle invasive bladder treatment.
Association of urinary tract infection and low albumin/globulin ratio with chemoresistance to gemcitabine-cisplatin in advanced urothelial carcinoma.
Lyu J, Yue R, Zhu Y … +2 more , Tian Y, Hu X
Can J Urol · 2025 Oct · PMID 41220351 · Publisher ↗
OBJECTIVE: Urothelial carcinoma (UC) remains a prevalent malignancy with high recurrence and chemoresistance rates despite gemcitabine-cisplatin (GC) chemotherapy. The study aimed to identify clinical risk factors for ch...
OBJECTIVE: Urothelial carcinoma (UC) remains a prevalent malignancy with high recurrence and chemoresistance rates despite gemcitabine-cisplatin (GC) chemotherapy. The study aimed to identify clinical risk factors for chemoresistance in advanced UC patients and develop a predictive model. METHOD: A retrospective analysis was conducted on 375 UC patients who received postoperative GC chemotherapy between 2013 and 2024. Patients were categorized into chemotherapy-resistant (CR, n = 91) and non-chemotherapy resistant (NCR, n = 284) groups based on tumor progression. Clinical, pathological, and laboratory variables were compared using t-tests and chi-square tests. Kaplan-Meier assessed overall survival (OS), and binary logistic regression identified independent predictors of chemoresistance. RESULT: Overall survival (OS) was significantly lower in the CR group than in the NCR group urinary tract infection (OR: 54.60; 95% CI: [21.19, 140.67]) and low A/G (OR: 0.18;95% CI: [0.03, 0.94]). The prediction model was: Logit(P)=-3.69+0.96×multifocal tumor+1.05×Tstage+4.00×long-termurinary tract infection(UTI)-1.73×A/G. CONCLUSION: Multifocality, high T stage, persistent UTI, and low A/G ratio are significantly associated with chemoresistance to GC in UC. These routine clinical indicators may support early identification of high-risk patients and guide treatment decisions.
Determination and assessing the role of serum calcium, vitamin D, ferritin, and uric acid levels on prostate cancer risk.
Bener A, Veli Üstündağ Ü, Barışık E … +1 more , Cahit Barışık C
Can J Urol · 2025 Oct · PMID 41220350 · Publisher ↗
OBJECTIVES: The evidence remains insufficient and controversial for evaluating modifiable parameters-such as vitamin D, calcium, ferritin, and uric acid-as preclinical biomarkers to contribute to the prevention and early...
OBJECTIVES: The evidence remains insufficient and controversial for evaluating modifiable parameters-such as vitamin D, calcium, ferritin, and uric acid-as preclinical biomarkers to contribute to the prevention and early diagnosis of prostate cancer, a disease with a prevalence of up to 10%-20% in men over 50 and strongly associated with environmental factors including diet (high in fat and red meat), obesity, physical inactivity, and carcinogen exposure. This study aims to investigate the potential biomarker role of vitamin D, calcium, ferritin, and uric acids in reducing the risk of prostate cancer (PCa). METHODS: The case-control design was employed, involving 496 PCa cases and 496 controls aged 35 and above. Data collection included sociodemographic details, radiological findings, clinical history, and biochemical markers. RESULTS: Advanced age, cigarette and hookah use, alcohol consumption, processed food intake, chemical exposure, obesity, poor dietary habits, stress, and reduced sleep duration were more prevalent in the PCa group (p < 0.05). Symptoms such as hematuria, anemia, infections, and fatigue were significantly increased (p < 0.001). Hypocalcemia (p < 0.001), vitamin D deficiency (p < 0.001), elevated uric acid levels (p < 0.001), increased ferritin (p = 0.005), and elevated systolic blood pressure (p = 0.004) were identified as key risk factors. CONCLUSION: The current study suggests that vitamin D, calcium, ferritin, and uric acids may serve as promising biomarkers for the detection of PCa. The rising incidence of PCa could be attributed to lifestyle, environmental, and hereditary factors, nutrition, alcohol consumption, hookah use, and cigarette smoking.
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