OBJECTIVE: To evaluate the feasibility of using convolutional neural networks (CNNs) and vision transformers (ViTs) to predict renal tumor pathology intraoperatively based on gross appearance. MATERIAL AND METHODS: Intra...OBJECTIVE: To evaluate the feasibility of using convolutional neural networks (CNNs) and vision transformers (ViTs) to predict renal tumor pathology intraoperatively based on gross appearance. MATERIAL AND METHODS: Intraoperative images were retrospectively extracted from surgical recordings of patients undergoing partial nephrectomy between 2008-2024. Static frames obtained prior to arterial clamping were curated and linked with final pathology. A ResNet50-based CNN and the General Surgery Vision Transformer (GSViT) were trained to classify six tumor types: clear cell RCC (ccRCC), papillary RCC (pRCC), chromophobe RCC (chRCC), hybrid oncocytic tumors, oncocytoma, and angiomyolipoma (AML). Models were trained with transfer learning, evaluated on held-out test data, and assessed using accuracy, AUC-ROC, and confusion matrices. RESULTS: A total of 443 images from 118 patients (136 surgeries) were analyzed, including ccRCC (n=149), pRCC (n=97), chRCC (n=42), hybrid tumors (n=81), oncocytoma (n=43), and AML (n=31). In binary classification, the CNN achieved the highest AUCs for ccRCC (0.74), chRCC (0.70), hybrid tumors (0.73), and AML (0.70). Multi-class CNN performance was more variable, with notable AUCs for pRCC (0.70) and oncocytoma (0.71). The GSViT model underperformed across most categories, demonstrating prediction bias toward ccRCC. Attempts to unfreeze pretrained backbones led to rapid overfitting, underscoring dataset limitations. CONCLUSION: CNN-based models demonstrate moderate ability to classify renal tumor pathology intraoperatively from gross appearance, providing proof of concept for AI-assisted surgical decision-making. Larger datasets and external validation are needed before clinical application.
BACKGROUND: Purple urine bag syndrome (PUBS) is an unusual but recognizable manifestation characterized by a striking purple hue in the urinary collection system. This phenomenon results from bacterial enzymatic breakdow...BACKGROUND: Purple urine bag syndrome (PUBS) is an unusual but recognizable manifestation characterized by a striking purple hue in the urinary collection system. This phenomenon results from bacterial enzymatic breakdown of tryptophan in the presence of alkaline urine. While often benign, PUBS can indicate an underlying infection, particularly in individuals with long-term catheterization and other risk factors, such as immobility and constipation. CASE PRESENTATION: We describe the case of a woman in her 40s with a prior cerebrovascular accident who was bedbound and dependent on a long-term indwelling catheter. She developed discoloration of her urine bag without systemic symptoms. Urine analysis revealed an alkaline pH and significant pyuria, and culture confirmed infection with Klebsiella pneumoniae. Management involves replacing the catheter, initiating culture-directed antibiotic therapy with levofloxacin, optimizing bowel habits, and promoting hydration. These interventions led to a full resolution of the discoloration and infection. CONCLUSION: Although visually alarming, PUBS often serves as a subtle clinical indicator of underlying urinary tract pathology. This case highlights the necessity of a multifactorial management approach, including microbiological evaluation, catheter hygiene, bowel regulation, and patient education. Early recognition of PUBS may help prevent escalation to more severe complications in vulnerable, catheter-dependent patients.
BACKGROUND: Urology presents unique challenges for AI systems, requiring both extensive medical knowledge and advanced reasoning. While large language models (LLMs) like GPT-4 have shown promise in medical education and...BACKGROUND: Urology presents unique challenges for AI systems, requiring both extensive medical knowledge and advanced reasoning. While large language models (LLMs) like GPT-4 have shown promise in medical education and decision support, their performance in urology remains underexplored. OBJECTIVE: To provide a time-stamped comparison of two representative large language models available at the time of evaluation, ChatGPT-4o and DeepSeek R1, in answering urology-related single-choice questions, and to evaluate their accuracy, stability, and response consistency across different response configurations. METHODS: A total of 809 single-choice questions from the Chinese National Qualification Examination for Attending Physicians in Urology were administered to ChatGPT-4o and DeepSeek R1. Each model was tested under three configurations: basic mode, deep-thinking mode, and web-enabled retrieval. Accuracy was calculated for each configuration, and statistical comparisons were performed using McNemar's test. Stability across reasoning modes was assessed by comparing performance variability. Additional analyses examined performance differences between short-answer and case-based clinical questions. RESULTS: ChatGPT-4o achieved accuracy rates of 78.12%, 73.79%, and 78.99% in basic, deep-thinking, and web-enabled retrieval modes, respectively. DeepSeek R1 outperformed ChatGPT-4o across all configurations, with accuracy rates of 83.19%, 81.46%, and 84.55%, respectively. All between-model differences were statistically significant (p < 0.001). DeepSeek R1 demonstrated greater internal stability across reasoning modes, whereas ChatGPT-4o showed notable variability. In subgroup analyses, DeepSeek R1 exhibited a more pronounced advantage in complex, case-based clinical questions. Both models performed consistently across urological disease categories, and findings were limited to the Chinese-language context in which the evaluation was conducted. CONCLUSION: DeepSeek R1 showed superior performance compared with ChatGPT-4o in both accuracy and stability when answering urology-related examination questions, particularly in complex case-based scenarios. These results suggest that optimized LLMs may have potential utility in urology education and examination-style question answering, especially within Chinese-language environments. However, these findings should not be interpreted as evidence of readiness for real-world clinical decision support, and further validation in clinically realistic settings is required.
Spinal cord injury (SCI) is a life-changing and costly condition. SCI causes major disturbances in sensory, motor and autonomic function, resulting in permanent loss of function and strongly affecting the physical, psych...Spinal cord injury (SCI) is a life-changing and costly condition. SCI causes major disturbances in sensory, motor and autonomic function, resulting in permanent loss of function and strongly affecting the physical, psychological and social well-being of patients and caregivers. A particularly debilitating consequence of SCI is loss of voluntary control over bladder function, which substantially affects patients' dignity, health and quality of life. Current understanding of the complex pathophysiological mechanisms of SCI and associated comorbidities has heavily relied on the use of animal models, which have also been crucial in devising new therapeutic approaches and fine-tuning existent ones. However, a debate about the persistent challenges in translating preclinical data into treatment is ongoing. Technological advances are generating innovative modelling approaches with the support of regulatory bodies, aiming to reduce or eventually substitute animal use. In this Review, we address the current use of animal SCI models in neuro-urological research and debate whether we will still be using these models by 2035.
OBJECTIVE: To analyze whole-mount (WM) pathology slides and to evaluate prostate ductal anatomy as a potential contrast mechanism for visualization of prostate cancer using micro-ultrasound. METHODS: Ten men scheduled to...OBJECTIVE: To analyze whole-mount (WM) pathology slides and to evaluate prostate ductal anatomy as a potential contrast mechanism for visualization of prostate cancer using micro-ultrasound. METHODS: Ten men scheduled to undergo radical prostatectomy for PCa were enrolled in an IRB-approved study. After prostatectomy, prostates were grossed, sectioned, and stained. All clinically significant PCa lesions were annotated by an experienced pathologist. The scanned slides were then analyzed using a custom computer vision script (MATLAB) to identify and quantify ductal features. Using the annotated lesions, binary masks were made to delineate benign and PCa groups. A color thresholding step was then applied to the tissue within each mask to select the white space where the prostate ducts are located. We extracted two main features: the duct equivalent diameter and the ductal ratio, defined as the proportion of tissue area occupied by prostate ducts. RESULTS: A total of 54 slides were processed, with 145,150 benign and 9,245 PCa ducts identified. The mean equivalent diameter of benign ducts was 155.7 ± 147.8 µm. PCa ducts had a mean equivalent diameter of 129.4 ± 94.3 µm. The average ductal ratio for benign tissue was 0.086 ± 0.029 and 0.039 ± 0.017 for PCa tissue. CONCLUSION: Prostate ducts are large enough to be resolved on micro-ultrasound but too small for conventional ultrasound. In addition, PCa tissue exhibits an approximate 50% reduction in ductal ratio, which highlights the potential of ductal anatomy as a contrast mechanism for PCa visualization using micro-ultrasound.
BACKGROUND: Flexible ureteroscopy (FURS) is widely considered a safe and effective modality for renal stone management. Severe infectious and hemorrhagic complications are uncommon but may be life-threatening. CASE-PRESE...BACKGROUND: Flexible ureteroscopy (FURS) is widely considered a safe and effective modality for renal stone management. Severe infectious and hemorrhagic complications are uncommon but may be life-threatening. CASE-PRESENTATION: A 75-year-old man was referred to our tertiary center with hemodynamic instability following FURS performed at an outside institution for the treatment of a renal calculus. He presented with septic shock and acute anemia. Contrast-enhanced computed tomography revealed a massive perirenal hematoma compressing the renal parenchyma. Despite aggressive resuscitation, broad-spectrum antibiotics, and intensive care management, the patient's clinical condition deteriorated. Emergency nephrectomy was performed as a life-saving intervention. CONCLUSION: This case highlights the potential for rare combined septic and hemorrhagic complications following FURS. Early recognition and timely referral to specialized centers are critical to reducing mortality and optimizing patient outcomes.
OBJECTIVE: To investigate the association of Cannabis Use Disorder (CUD) with new diagnoses of lower urinary tract symptoms (LUTS) in a young adult cohort. METHODS: Using the TriNetX database, we identified patients aged...OBJECTIVE: To investigate the association of Cannabis Use Disorder (CUD) with new diagnoses of lower urinary tract symptoms (LUTS) in a young adult cohort. METHODS: Using the TriNetX database, we identified patients aged 18-34 and stratified by sex and CUD diagnosis into cohorts. Propensity score matching was utilized on demographics and variables potentially affecting LUTS. The primary outcomes were 5-year risks of new onset lower urinary tract diagnoses, including all-cause LUTS, dysuria, pelvic/perineal pain, overactive bladder, and urinary tract infection, among patients with CUD compared to controls. RESULTS: We identified 101,761 and 67,110 matched pairs of males and females, respectively. At 5-year follow-up, CUD was associated with a higher risk of new onset of all-cause LUTS in males (RR 1.69, 95% CI 1.60-1.80, P <.01) and females (RR 1.81, 95% CI 1.73-1.89, P <.01) compared to controls. Increased risks of dysuria, pelvic/perineal pain, and urinary tract infection were observed in both male and female CUD patients compared to controls (all P <.01). CUD was not associated with overactive bladder in either males or females. CONCLUSION: In a cohort of young adults, CUD was associated with a greater risk of developing LUTS in both men and women. Further research is needed to define the impact of cannabinoids on lower urinary tract function.
BACKGROUND: Growing evidence indicates that the pre-operative ratio of fibrinogen to albumin (FAR/AFR) can act as a prognostic predictor for different kinds of cancer. Although a previous meta-analysis briefly involved u...BACKGROUND: Growing evidence indicates that the pre-operative ratio of fibrinogen to albumin (FAR/AFR) can act as a prognostic predictor for different kinds of cancer. Although a previous meta-analysis briefly involved urological malignancies, it only incorporated one study for bladder cancer (BC) and one for renal cell carcinoma (RCC) with limited data. To date, a comprehensive and systematic quantitative assessment of plasma FAR/AFR as a prognostic indicator in urological cancers remains lacking. OBJECTIVE: This meta-analysis intended to comprehensively investigate the prognostic significance of plasma FAR/AFR in individuals with urological malignancies. METHODS: A thorough search of the PubMed, Embase, and Web of Science databases was carried out up to March 2026, leading to the incorporation of 6 studies for this meta-analysis. The research computed hazard ratios (HRs) together with their 95% confidence intervals (CIs) to evaluate disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). RESULTS: The study included a total of 1,603 participants. Patients suffering from RCC and BC who showed an increase in pre-operation FAR or a decrease in pre-operation AFR had poorer overall survival (combined HR = 2.36, 95% CI = 1.92-2.91; p < 0.001), cancer-specific survival (combined HR = 2.27, 95% CI = 1.77-2.91; p = 0.003), and disease-free survival (combined HR = 2.32, 95% CI = 1.62-3.31; p < 0.001).Analysis based on cancer type showed that an increased pre-surgical FAR or a decreased pre-surgical AFR was associated with poorer overall survival in RCC) (combined HR = 3.19, 95% CI = 1.84-5.54, p < 0.001) and also in BC (combined HR = 2.25, 95% CI = 1.80-2.81, p < 0.001). CONCLUSIONS: Increased FAR or decreased AFR act as independent markers of unfavorable survival prognosis in patients with RCC and BC.
BACKGROUND: Prostatitis, particularly chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), remains a common yet challenging condition in urological practice, largely due to its heterogeneous etiology, diagnostic c...BACKGROUND: Prostatitis, particularly chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), remains a common yet challenging condition in urological practice, largely due to its heterogeneous etiology, diagnostic complexity, and high levels of patient anxiety. Increasingly, patients seek information about prostatitis from short-video platforms; however, the quality and clinical relevance of such content remain unclear. METHODS: A cross-sectional content analysis was conducted to evaluate prostatitis-related videos on TikTok and Bilibili. Video characteristics, engagement metrics, uploader type, and content themes were extracted. Information quality and reliability were assessed using the Global Quality Scale (GQS) and the modified DISCERN (mDISCERN) instrument, while content completeness was evaluated using a six-domain clinical information framework. Comparisons were performed across platforms and uploader categories, and correlations between engagement metrics and quality indicators were analyzed. RESULTS: A total of 223 videos were included. Overall information quality and reliability were moderate. Content distribution was heavily skewed toward treatment-related information, whereas disease awareness, diagnostic principles, and preventive or long-term management content were markedly underrepresented. Videos uploaded by healthcare professionals demonstrated significantly higher quality, reliability, and content completeness than those from non-professional sources. TikTok videos achieved higher overall quality and reliability scores compared with Bilibili. Engagement metrics showed only weak correlations with information quality and reliability indicators. CONCLUSION: Prostatitis-related information on short-video platforms is characterized by moderate quality and substantial structural imbalance, with an overemphasis on treatment and insufficient coverage of diagnostic reasoning and long-term management. From a urological clinical perspective, incomplete or misleading online information may shape patient expectations and has the potential to complicate clinical communication and shared decision-making, particularly regarding diagnostic evaluation, antibiotic expectations, and long-term management. Greater involvement of urologists in structured digital patient education and the promotion of clinically accurate content are needed to mitigate misinformation and improve patient understanding.
BACKGROUND: Overactive bladder (OAB) is commonly managed with antimuscarinic agents, although tolerability limits long-term adherence. Tibial nerve stimulation (TNS) has emerged as a non-pharmacologic alternative. This s...BACKGROUND: Overactive bladder (OAB) is commonly managed with antimuscarinic agents, although tolerability limits long-term adherence. Tibial nerve stimulation (TNS) has emerged as a non-pharmacologic alternative. This study compared the efficacy and safety of TNS versus solifenacin in women with OAB. METHODS: In this randomized controlled clinical trial, 118 patients met OAB diagnostic criteria, who presented to Qaem Hospital (Mashhad, Iran, 2023). Participants were randomly assigned to receive 12 weeks of either TNS (two 30-minute sessions weekly) or oral solifenacin (5 mg daily). Primary outcomes included changes in OAB symptom severity, urinary incontinence, and quality of life scores, using validated questionnaires at baseline and week 12. Statistical analysis was conducted using SPSS version 22, with significance set at p < 0.05. RESULTS: Both treatments led to significant improvement in OAB symptoms, urinary incontinence severity, and quality of life (all p < 0.001). TNS produced slightly greater improvement in OAB symptom severity (p = 0.016) and significantly greater reduction in urinary incontinence severity (p = 0.015). Quality of life improved substantially in both groups (p < 0.001), with comparable post-treatment scores. Adverse effects occurred in 88.1% of solifenacin users, whereas no side effects were reported with TNS. CONCLUSION: TNS is an effective and well-tolerated treatment for OAB, offering superior improvement in urinary incontinence and a markedly better safety profile compared with solifenacin. TNS may represent a preferable non-pharmacologic alternative for patients who cannot tolerate or do not respond adequately to anticholinergic medications. Future studies with larger cohorts and extended follow-up durations would be beneficial to validate and expand upon our findings. TRIAL REGISTRATION: The study protocol was officially registered in the Iranian Registry of Clinical Trials under the identifier IRCT20190618043934N25 on 2024-05-13.
Urothelial carcinoma is a common malignancy of the urinary tract and occurs predominantly in elderly men. Although surgery, chemotherapy, and radiotherapy remain the main treatment options, their efficacy in advanced dis...Urothelial carcinoma is a common malignancy of the urinary tract and occurs predominantly in elderly men. Although surgery, chemotherapy, and radiotherapy remain the main treatment options, their efficacy in advanced disease is often limited, particularly in elderly patients with comorbidities or poor surgical tolerance. Antibody-drug conjugates (ADCs) combined with immune checkpoint inhibitors have recently emerged as a promising therapeutic strategy. We report the case of a 79-year-old man with advanced urothelial carcinoma who declined radical cystectomy and received disitamab vedotin plus toripalimab. Histopathological examination confirmed high-grade muscle-invasive urothelial carcinoma, and supplementary immunohistochemistry showed HER2 expression of 1+. FISH/ISH and PD-L1 testing were not performed. The patient received treatment every 3 weeks over 2 consecutive days, with disitamab vedotin on day 1 and toripalimab on day 2. After 6 cycles, imaging showed marked tumor regression, and repeat transurethral resection of the tumor bed revealed no residual tumor cells, consistent with pathological complete response. The treatment was generally well tolerated, with only mild fatigue and nausea. This case suggests that disitamab vedotin combined with toripalimab may have activity in selected patients with advanced urothelial carcinoma, including those with low HER2 expression. However, the findings should be interpreted cautiously, and further studies are needed to clarify the role of this regimen and the value of predictive biomarkers.
Xanthogranulomatous pyelonephritis is an uncommon destructive inflammatory process of the renal parenchyma associated with urinary tract obstruction and infection. Preoperative diagnosis remains challenging with correct...Xanthogranulomatous pyelonephritis is an uncommon destructive inflammatory process of the renal parenchyma associated with urinary tract obstruction and infection. Preoperative diagnosis remains challenging with correct identification in less than half of cases. Management paradigms include immediate surgical intervention or staged approaches that emphasize preoperative optimization and percutaneous drainage. Radical nephrectomy remains the de facto definitive treatment though critical evidence gaps underscore the need for more rigorous study to guide management.
OBJECTIVE: To measure faculty-trainee agreement regarding operative autonomy and performance and identify facilitators and barriers to engagement. METHODS: Urology faculty and trainees completed SIMPL assessments within...OBJECTIVE: To measure faculty-trainee agreement regarding operative autonomy and performance and identify facilitators and barriers to engagement. METHODS: Urology faculty and trainees completed SIMPL assessments within 72 hours of operative cases performed between August 2019 and July 2020. Trainee autonomy, performance, and case complexity were measured. Faculty-trainee agreement was quantified using weighted kappa coefficients and 95% confidence intervals. Post-intervention participant reactions were elicited via survey for feasibility assessment. RESULTS: 480 assessments were completed (17 trainees, 52.1%; 20 faculty, 47.9%). 188 paired assessments were analyzed. Faculty-trainee agreement was moderate for autonomy (kappa = 0.55, 95% CI: 0.45-0.65) and surgical performance (kappa = 0.47, 95% CI: 0.34-0.59), but low for case complexity (kappa = 0.38, 95% CI: 0.27-0.50). The most common criticism was lack of reminders for faculty to complete assessments, cited by 50% of residents and 37% of faculty. CONCLUSIONS: Our institution is the first to integrate SIMPL assessment into urology residency training, demonstrating its feasibility for operative assessment. Moderate agreement was exhibited in autonomy and performance assessments, while lower agreement on case complexity suggests differing perceptions of surgical difficulty. Notably, faculty rated trainees higher in autonomy compared to self-assessments. Future investigations should explore contributing factors to these differences and address barriers, such as reminders for assessment completion.
BACKGROUND: High sodium intake has been linked to kidney stone formation in many observational studies, but these findings may be influenced by dietary habits and fluid intake. Whether urinary sodium itself plays a causa...BACKGROUND: High sodium intake has been linked to kidney stone formation in many observational studies, but these findings may be influenced by dietary habits and fluid intake. Whether urinary sodium itself plays a causal role in urolithiasis remains unclear. METHODS: We performed a two-sample Mendelian randomization analysis to examine the association between urinary sodium excretion and urolithiasis risk. Genetic instruments for urinary sodium were obtained from large genome-wide association studies based on the UK Biobank and EBI databases (N > 300,000). Summary statistics for urolithiasis were derived from the FinnGen R12 dataset. The primary analysis was conducted using the inverse variance weighted method, with additional sensitivity analyses including MR-Egger, weighted median, and MR-PRESSO. RESULTS: Higher genetically predicted urinary sodium excretion was associated with an increased risk of urolithiasis (IVW OR = 2.49, 95% CI: 1.45-4.29, P= 0.00099). Similar results were observed in an independent replication dataset (OR = 2.66, 95% CI: 1.39-5.07, P= 0.0029). There was no evidence of horizontal pleiotropy (MR-Egger intercept P= 0.523), and heterogeneity was low. MR-PRESSO did not detect any significant outliers. CONCLUSIONS: Our findings provide supportive genetic evidence suggesting that higher urinary sodium excretion may contribute to an increased risk of urolithiasis. These results align with current recommendations for dietary sodium restriction in stone prevention.
OBJECTIVE: To investigate healthcare utilization (HCU) and expenditures across bladder cancer (BCa), other cancers, and non-cancer groups and to assess for racial and ethnic disparities. PATIENTS AND METHODS: Using the M...OBJECTIVE: To investigate healthcare utilization (HCU) and expenditures across bladder cancer (BCa), other cancers, and non-cancer groups and to assess for racial and ethnic disparities. PATIENTS AND METHODS: Using the Medical Expenditure Panel Survey (2015-2022), we identified 165,665 respondent-year observations from 85,194 unique individuals and categorized respondents as BCa, non-BCa cancers (prostate, colorectal, lung, melanoma, lymphoma, breast, gynecologic), or no cancer history. Survey-weighted regression models were used to compare and estimate incidence rate ratios of annual HCU (a composite of emergency, outpatient, inpatient encounters, prescriptions) and expenditures (total and out-of-pocket). RESULTS: Among 165,665 respondent-years (mean age 55.7 y), 0.2% had BCa, 4.5% other cancers, and 95.3% no cancer. Compared to BCa, adjusted total composite physician interactions were similar in the no-cancer group (IRR 0.97, 95% CI 0.85-1.11) and the non-BCa cancers (IRR 1.10, 0.96-1.26). Non-BCa patients had fewer ED visits than BCa patients (IRR 0.65, 0.46-0.92). Compared to BCa patients, adjusted total spending was significantly lower in no-cancer patients (IRR 0.74, 0.59-0.91), whereas adjusted OOP spending did not differ. Total and OOP spending were also similar between BCa and non-BCa patients. Racial/ethnic minority patients had higher total physician interaction (IRR 1.97, 1.26-3.09), outpatient visits (IRR 2.54, 1.56-4.12) and total healthcare expenditures (IRR 1.73, 1.01-2.97) than non-Hispanic White patients. CONCLUSIONS: BCa patients showed significantly higher HCU in emergency visits compared to both non-cancer and other cancer patients. BCa patients did not incur higher expenses than other malignancies. Disparities in HCU and expenditure stratified by race/ethnicity were evident and most pronounced among BCa patients.