Urology[JOURNAL]
Sun
200 papers
Association between inflammatory burden index and erectile dysfunction: a retrospective case-control study.
Arslan A, Benli E, Yüce A … +1 more , Sevgi F
BMC Urol · 2026 Jun · PMID 42243778 · Full text
BACKGROUND: Erectile dysfunction (ED) is a vascular disease associated with systemic inflammation and endothelial dysfunction. The role of inflammatory markers in the pathogenesis of ED is gaining increasing importance....
BACKGROUND: Erectile dysfunction (ED) is a vascular disease associated with systemic inflammation and endothelial dysfunction. The role of inflammatory markers in the pathogenesis of ED is gaining increasing importance. This study aimed to evaluate the relationship between the Inflammatory Burden Index (IBI), calculated by combining C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), and erectile dysfunction. METHODS: This retrospective study included 126 patients with erectile dysfunction and 128 healthy controls who presented to the urology outpatient clinic between January 2023 and October 2025. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5). NLR was calculated as the ratio of absolute neutrophil count to absolute lymphocyte count, and IBI was obtained using the formula CRP × NLR. Diagnostic performance was examined using ROC analysis. Multivariate logistic regression analysis was performed to identify independent risk factors for erectile dysfunction. RESULTS: IBI values were found to be significantly higher in the ED group compared to the control group (median 3.31 vs. 0.91, p < 0.001). No significant difference was found between the groups in terms of NLR. There was no significant difference in IBI values between the ED severity groups (p = 0.346). ROC analysis showed modest discriminatory ability of IBI for ED (AUC = 0.754; 95% CI: 0.696-0.813; p < 0.001). Based on the Youden index, the optimal cutoff value was 3.785, with sensitivity 43.7% and specificity 84.3% (Youden index = 0.280). Additionally, a weak positive correlation was found between IBI and body mass index (r = 0.197; p = 0.027). In multivariate logistic regression analysis, diabetes mellitus and cardiovascular disease were identified as independent predictors of erectile dysfunction, while IBI was not found to be an independent predictor. CONCLUSIONS: IBI levels were significantly higher in patients with erectile dysfunction and may reflect systemic inflammatory burden associated with ED. However, because IBI was not an independent predictor in multivariable analysis and its discriminatory performance remained modest, its clinical utility as a standalone diagnostic or screening marker appears limited.
The clinical utility of prostate MRI before biopsy.
Chestnut C, McKoy T, Westphalen AC … +2 more , Lin DW, Nyame YA
Nat Rev Urol · 2026 Jun · PMID 42243439 · Publisher ↗
Approximately 1 in 8 men are diagnosed with prostate cancer during their lifetime. However, long-term data have shown that as many as half of diagnosed prostate cancers have low lethal potential. Early detection of prost...
Approximately 1 in 8 men are diagnosed with prostate cancer during their lifetime. However, long-term data have shown that as many as half of diagnosed prostate cancers have low lethal potential. Early detection of prostate cancer relying on PSA alone is associated with potential harm to patients owing to false-positive results, prostate biopsy-related complications and over-detection and over-treatment of low-risk cancers. Multiparametric MRI offers an adjunctive strategy for improving the diagnostic yield of prostate biopsy and also for potentially reducing the need for biopsy in selected patients. Prostate MRI can increase the detection of clinically significant prostate cancer through targeted biopsy, especially in patients with a previous negative biopsy who did not undergo initial imaging. Prostate MRI improves clinically significant cancer detection, potentially reducing biopsy burden in patients on active surveillance.
Restoring time lost to race-based medicine.
Gheordunescu G, Vince RA
Nat Rev Urol · 2026 Jun · PMID 42243438 · Publisher ↗
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Perioperative Predictors of Length of Stay and Readmission After Simple Cystectomy and Urinary Diversion in Nonambulatory Adults With Neurogenic Bladder.
Howland R, Sawyer K, Seibel C … +2 more , Daignault-Newton S, Stoffel JT
Urology · 2026 Jun · PMID 42242393 · Publisher ↗
OBJECTIVE: To identify factors associated with readmission and length of stay (LOS) after simple cystectomy in neurogenic patients to inform Enhanced Recovery After Surgery (ERAS) pathway development. ERAS protocols impr...
OBJECTIVE: To identify factors associated with readmission and length of stay (LOS) after simple cystectomy in neurogenic patients to inform Enhanced Recovery After Surgery (ERAS) pathway development. ERAS protocols improve outcomes after oncologic cystectomy, but guidance for neurogenic populations is limited. METHODS: This retrospective study identified patients with Multiple Sclerosis (MS), Spinal Cord Injury (SCI), Spina Bifida (SB), or related conditions who underwent cystectomy (2013 and 2023). Exclusion criteria were age ≤18, cystectomy without diversion, and ambulatory patients. Primary outcomes were LOS and readmission. Secondary outcomes were ileus and wound complications. Associations were analyzed using Wilcoxon, Fisher's exact, Spearman, and Kruskal-Wallis tests. RESULTS: Eighty-five patients were included (55% male; median age 52; 43 SCI, 20 MS, 16 SB, and 6 others). Median LOS was 7 days. Thirty-day readmission occurred at 24%. Longer LOS was associated with older age (ρ = 0.23, P = .033), lower preoperative hemoglobin (ρ = -0.26, P = .016), and greater blood loss (ρ = 0.25, P = .023). Postoperative ileus (P < .001), total parenteral nutrition use (P < .001) and wound complications (P < .001) were associated with prolonged hospitalization. Longer operative time predicted readmission (540 vs 435 minutes, P = .04). Discharge home showed a nonsignificant trend toward higher readmission than facility discharge (29% vs 12%, P = .10). CONCLUSION: Longer hospitalization was associated with older age, lower hemoglobin, greater blood loss, and postoperative complications. Longer operative time predicted readmission. These findings identify modifiable targets for ERAS pathways tailored to neurogenic patients.
Altered Epithelial Differentiation in Urethral Stricture Disease Is Characterized by Increased Keratin 14, 6A, and 16 Expression.
Richmond E, Erickson BA, Grimes MD
Urology · 2026 Jun · PMID 42242392 · Publisher ↗
OBJECTIVE: To test the hypothesis that basal epithelial keratin 14 (KRT14) expression and superficial KRT6a and KRT16 expression are increased in urethral stricture disease (USD) compared to non-strictured urethra (NU),...
OBJECTIVE: To test the hypothesis that basal epithelial keratin 14 (KRT14) expression and superficial KRT6a and KRT16 expression are increased in urethral stricture disease (USD) compared to non-strictured urethra (NU), and are positively associated with the severity of immune cell infiltration. METHODS: We used multiplexed fluorescent immunohistochemistry to identify KRT5 (a basal epithelial marker), KRT14, KRT6a, KRT16, and CD45 (an inflammatory cell marker) in NU obtained from autopsy decedents and USD specimens with and without lichen sclerosus (LS-USD) obtained from urethral biopsy and urethroplasty. The relative abundance of positively staining cells was compared with respect to tissue/stricture types and immune cell infiltration using Mann-Whitney U tests and linear regression. RESULTS: We analyzed 15 patients (3 Normal, 6 USD, 6 LS-USD). Expression of KRT14, 6a, and 16 was significantly higher in both USD and LS-USD compared to NU (P < .05 for all). KRT 14 expression was not associated with histologic inflammation in either (P = .995) or LS-USD (P = .672). CONCLUSION: We identified increased expression of epithelial KRT14, 6a, and 16 in USD and LS-USD compared with NU. This pattern of altered epithelial differentiation in the setting of chronic inflammation mirrors changes seen in response to acute epithelial injury and subsequent chronic inflammation in other organ systems. These hypothesis-generating results suggest further study of the downstream effects of these changes, including increased epithelial permeability due to compromised barrier function.
Delayed Removal of the Noninfected Artificial Urinary Sphincter Has Comparable Outcomes to Immediate Removal.
Yu C, Martinez M, Dvergsten T … +7 more , Hu MY, Nose B, Sury K, Krughoff K, Lentz AC, Peterson AC, Foreman JR
Urology · 2026 Jun · PMID 42242391 · Publisher ↗
OBJECTIVE: To compare the clinical outcomes of immediate removal (IR) vs delayed removal (DR) of a patients presenting with eroded, clinically noninfected artificial urinary sphincters (AUS). METHODS: We examined our pro...
OBJECTIVE: To compare the clinical outcomes of immediate removal (IR) vs delayed removal (DR) of a patients presenting with eroded, clinically noninfected artificial urinary sphincters (AUS). METHODS: We examined our prospectively maintained AUS quality improvement database from 2009 to 2024. Patients without clinical signs of infection were included. Patients with suspected infection defined by SIRS criteria and/or infectious symptoms (fever >101.5 °F, scrotal erythema/swelling, purulence, or extrusion) were excluded. Patients were stratified by time of diagnosis to removal, IR defined as <24 hours from diagnosis or same calendar day, and DR defined as >24 hours from diagnosis or at least next calendar day. Complication rate after explantation (persistent extravasation, urethral stricture, urethrocutaneous fistula, scrotal abscess/cellulitis, and pubic osteomyelitis) was compared between groups. RESULTS: 53 explantations of 110 erosions met inclusion criteria (IR, n = 15; DR, n = 38). Median device age at erosion was 17 months (IQR 8-94) in the IR group and 10.5 months (4-47.5) in the DR group. Median time of diagnosis to AUS removal was 0 days (IQR 0-1) and 4 days (IQR 2-5.3) for IR and DR groups, respectively. At a median follow-up of 353 days (IQR 103.5-1361.5), there was no significant difference between IR and DR groups in the presence of complications in patients (33% and 42% respectively, P = .782). CONCLUSION: Despite the traditional teaching that immediate removal is necessary for all AUS erosions, the outcomes of immediate and delayed removal of clinically noninfected, eroded AUS devices are not statistically different and likely have comparable outcomes.
Minimally invasive treatment of emphysematous pyelonephritis in diabetic patients: a comparative study.
Li S, Zheng J, Song Y … +1 more , Fan L
BMC Urol · 2026 Jun · PMID 42237157 · Full text
OBJECTIVE: Emphysematous pyelonephritis (EPN) is a rare but high-mortality infectious disease most commonly seen in diabetic patients, and the timing of percutaneous catheter drainage (PCD) is crucial for its prognosis....
OBJECTIVE: Emphysematous pyelonephritis (EPN) is a rare but high-mortality infectious disease most commonly seen in diabetic patients, and the timing of percutaneous catheter drainage (PCD) is crucial for its prognosis. METHODS: A retrospective analysis was conducted on data of 18 patients diagnosed with diabetes mellitus complicated EPN who were treated in the Urology of the General Hospital of Northern Theater Command between November 2019 and March 2024. The patient cohort was stratified into two groups according to the timing of PCD implementation: the Early PCD group (E-PCD group, n = 11) (≤ 24 h) and the Delayed Salvage PCD group (DS-PCD group, n = 7) (converted to PCD after failure of conservative pharmacotherapy). By comparing of the comprehensive indicators, the clinical value of early PCD was clarified. RESULT: The general status recovery time, average hospitalization time, average recovery time, and the recovery time of related infection indicators at multiple sampling time points after treatment in the E-PCD group were significantly shorter than those in the DS-PCD group. The volume change rate of pus cavity of E-PCD was significantly higher than that of DS-PCD group at different unit time periods respectively. CONCLUSIONS: Compared with delayed salvage PCD, early ultrasound-guided PCD within 24 h in diabetic patients with EPN can effectively drain pus, quickly control infection symptoms, and accelerate patient recovery.
Editorial Comment on "Preliminary Use of Indocyanine Green-FA in Predicting the Blood Perfusion of Neourethra Covering in TIP Hypospadias Repair".
Jacobson D
Urology · 2026 Jun · PMID 42235758 · Publisher ↗
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Editorial Comment: "The Qualitative Experience of Early-Career Urologists: Challenges, Fulfillment, Support, and Advice".
Spencer K, Harris A
Urology · 2026 Jun · PMID 42235757 · Publisher ↗
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Postoperative foreign body retention following anal injury leading to a giant bladder stone: a case report.
Wang S, Tian Y, Zhou X … +4 more , Wang P, Ye P, Lu Y, Yu A
BMC Urol · 2026 Jun · PMID 42231305 · Full text
PURPOSE: Penetrating anal injuries resulting from falls from height are a rare form of high-energy trauma, often accompanied by multiple organ injuries and delayed complications; giant bladder stones caused by retained w...
PURPOSE: Penetrating anal injuries resulting from falls from height are a rare form of high-energy trauma, often accompanied by multiple organ injuries and delayed complications; giant bladder stones caused by retained wooden foreign bodies are particularly rare and highly prone to misdiagnosis. This study reports a case of this rare condition and highlights the key factors for achieving the best possible outcome. METHODS: This study presents the case of a 14-year-old male patient who sustained multiple penetrating anal injuries caused by a wooden foreign body following a fall from a height. Abdominal CT was used to assess the location of the foreign body and the extent of organ injury; the patient underwent emergency open abdominal surgery and transcatheter arterial embolisation for haemostasis, followed by long-term follow-up involving further imaging and interventional procedures as new symptoms arose. RESULTS: Initial abdominal CT revealed a foreign body in the abdomen and pelvis, accompanied by ileal and bladder injuries. Gross hematuria was present at admission, and urinary catheterization was maintained for 14 days postoperatively. The patient was discharged on postoperative day 20. Following emergency surgery and embolisation, the patient was discharged on the 20th postoperative day. Eight and a half years later, the patient developed lower urinary tract symptoms; a urinary tract CT scan revealed a giant bladder stone surrounding the residual foreign body, and the patient made a full recovery following surgical removal. CONCLUSION: For such patients, early and accurate diagnosis, prompt emergency surgery, thorough intraoperative exploration, objective assessment of bladder healing, and continuous long-term follow-up are crucial for preventing late complications and achieving the best possible outcomes.
A hypervascular perivascular epithelioid cell tumor of the urinary bladder showing TFE3 immunoreactivity clinically misdiagnosed as paraganglioma in an adolescent patient.
Ou M, Ji C, Wen J
BMC Urol · 2026 Jun · PMID 42231283 · Full text
Perivascular epithelioid cell tumor (PEComa) of the urinary bladder is an exceptionally rare mesenchymal neoplasm and may be difficult to diagnose preoperatively. We report a rare case of a hypervascular bladder PEComa w...
Perivascular epithelioid cell tumor (PEComa) of the urinary bladder is an exceptionally rare mesenchymal neoplasm and may be difficult to diagnose preoperatively. We report a rare case of a hypervascular bladder PEComa with TFE3 expression in an adolescent female that was clinically misdiagnosed as paraganglioma. A 16-year-old girl presented with intermittent gross hematuria. Imaging revealed a hypervascular submucosal bladder mass with marked homogeneous enhancement on computed tomography urography (CTU) and mild-to-moderate uptake on somatostatin receptor imaging, leading to suspicion of paraganglioma and preoperative α-adrenergic blockade. Histopathologic examination after transurethral resection showed epithelioid tumor cells with a low proliferative index. Immunohistochemistry demonstrated nuclear TFE3 positivity and strong cathepsin K expression, while melanocytic and neuroendocrine markers were negative, supporting a diagnosis of PEComa showing TFE3 immunoreactivity. The patient remains disease-free at six months of follow-up. This case highlights an important diagnostic pitfall of hypervascular bladder tumors mimicking paraganglioma, particularly in adolescent patients.
Reply to 'Polypropylene mesh degradation and systemic disease: biological plausibility is not clinical evidence'.
Farr NTH, Achenbach P, Sievert KD
Nat Rev Urol · 2026 Jun · PMID 42231017 · Publisher ↗
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Polypropylene mesh degradation and systemic disease: biological plausibility is not clinical evidence.
Chughtai B, Polo J, Goldman HB
Nat Rev Urol · 2026 Jun · PMID 42231016 · Publisher ↗
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Focal Cryo-Ablation for Treatment of Intermediate Favorable Risk (Grade Group 2) Prostate Cancer.
Lepor H, Fiske J, Tafa M … +2 more , Pirraglia E, Wysock JS
Urology · 2026 Jun · PMID 42229815 · Publisher ↗
OBJECTIVE: To report 7-year oncological outcomes of focal cryo-ablation (FCA) for focal intermediate favorable-risk prostate cancer (IFRPCa). PATIENTS AND METHODS: Beginning March 2017, all men with focal IFRPCa undergoi...
OBJECTIVE: To report 7-year oncological outcomes of focal cryo-ablation (FCA) for focal intermediate favorable-risk prostate cancer (IFRPCa). PATIENTS AND METHODS: Beginning March 2017, all men with focal IFRPCa undergoing FCA meeting the following eligibility criteria were enrolled in our longitudinal prospective study: a single MRI Prostate Imagine-Reporting and Data System (PIRADS) 2-5 target concordant with unilateral IFRPCa, no gross extraprostatic extension or very distal apical disease on MRI, and no Grade Group (GG) ≥2 contralateral to the MRI target. The oncological surveillance protocol included PSA testing every 6 months and MRI testing at 6-12 months, 2, 3.5, 5.0, and 7.5 years. Prostate biopsy was performed for rising PSA, suspicious MRI's or at the discretion of the surgeons. The main outcome measure was clinically significant prostate cancer (csPCa) recurrence. RESULTS: Two hundred seventy-six men were enrolled in the study. Overall, 39 (14.1%) developed a csPCa recurrence. Baseline mean PSA was significantly greater in subjects developing csPCa recurrence. There were no prostate cancer mortalities, and 3 (0.01%) developed metastasis. The csPCa recurrence-free survival at 3, 5, and 7 years was 90.20%, 78.36%, and 70.31%, respectively. African American race was the only significant independent predictor for developing a csPCa recurrence. Compliance with protocol MRI at 7.5 years was 90.9%. CONCLUSION: The present study supports FCA as a treatment option for focal IFRPCa associated with an MRI target with no evidence of extra-capsular extension or distal apical disease on MRI, and no contralateral GG >1 disease.
Insomnia in Urologic Chronic Pelvic Pain Syndrome: Prevalence, Psychosocial Influences, and Clinical Implications.
McKernan LC, Walsh EG, Kelly AG … +6 more , Sutherland S, Longo J, Amponsah A, Gudleski GD, O'Leary P, Lackner JM
Urology · 2026 Jun · PMID 42229814 · Publisher ↗
OBJECTIVE: To understand how disease-based and other psychosocial factors influence insomnia disorder in urologic chronic pelvic pain syndrome (UCPPS), this study examined rates of insomnia disorder in UCPPS, factors ass...
OBJECTIVE: To understand how disease-based and other psychosocial factors influence insomnia disorder in urologic chronic pelvic pain syndrome (UCPPS), this study examined rates of insomnia disorder in UCPPS, factors associated with insomnia disorder in UCPPS, and the relative impacts of urinary, cognitive, and affective factors in predicting insomnia disorder likelihood in UCPPS. METHODS: Individuals with UCPPS and clinically significant chronic pelvic pain were recruited to an ongoing clinical trial. This study examined baseline data from validated self-report measures capturing genitourinary symptoms, affective distress, cognitive patterns, and a formal diagnostic interview evaluating insomnia disorder. We assessed insomnia prevalence, its relation to clinical characteristics, and the odds of insomnia disorder given a person's urinary symptoms, anxiety, and pain catastrophizing using correlation and binomial logistic regression. RESULTS: Of the full sample (N = 152), 24.3% of participants met criteria for insomnia disorder (36% male, 22% female). Insomnia diagnosis was correlated with cognitive-affective symptoms but not with genitourinary symptoms. Model results indicated that anxiety predicted odds of meeting criteria for insomnia disorder above and beyond urinary severity and pain catastrophizing (OR = 1.05, P = .007). CONCLUSION: The estimated prevalence of insomnia disorder in our sample is nearly double the population rate. The odds of insomnia disorder are influenced by a person's anxiety level. In addition to addressing urinary symptoms, clinical intervention targeting anxiety may benefit patients with UCPPS suffering from insomnia.
Association between renal replacement therapy and in-hospital mortality in patients with severe acute kidney injury: a retrospective cohort study based on MIMIC-IV database.
Tian G, Lin Z, Chen Z … +8 more , Qiu Z, Zheng Z, Lin Y, Chen T, Xu Z, Cai Y, Wu K, Li X
BMC Urol · 2026 Jun · PMID 42226256 · Full text
BACKGROUND: Severe acute kidney injury (AKI) occurs frequently in intensive care unit (ICU) settings and correlates strongly with adverse patient outcomes. Whether renal replacement therapy (RRT) can effectively improve...
BACKGROUND: Severe acute kidney injury (AKI) occurs frequently in intensive care unit (ICU) settings and correlates strongly with adverse patient outcomes. Whether renal replacement therapy (RRT) can effectively improve mortality outcomes in these patients remains controversial, primarily due to interference from confounding by indication. Within nephrology and critical-care practice, identifying which severe-AKI subgroups derive a survival benefit from RRT is a question of direct bedside relevance, and observational analyses with rigorous bias control are particularly informative when balanced randomised data remain limited. METHODS: This retrospective cohort analysis utilized the MIMIC-IV database (version 2.2). The study population comprised adult patients (age ≥ 18 years) diagnosed with KDIGO Stage 3 AKI during their first ICU admission. Vascular causes of AKI (renal-artery stenosis, renal infarction, abdominal-aortic-aneurysm associated ischaemia) and clearly post-obstructive AKI were excluded a priori, as these phenotypes carry distinct trajectories that may not respond to RRT in a comparable manner. Patients were stratified into treatment and control groups based on RRT receipt. The clinical indication for RRT was operationalised through a composite set of pre-specified criteria (refractory hyperkalaemia, severe metabolic acidosis, refractory volume overload, uraemic complications, and oligo-anuria) that were entered into the propensity-score model in addition to severity scores and laboratory derangement, in order to reduce residual operator-dependent variation in the initiation decision. To address baseline characteristic differences, propensity score matching (PSM) was conducted using 1:1 nearest neighbor matching with a caliper of 0.02. The primary endpoint was in-hospital all-cause mortality; secondary endpoints encompassed ICU mortality, 28-day mortality, ICU length of stay, total hospital length of stay, RRT-related complications (catheter-associated bloodstream infection, mechanical line complications, bleeding events, and intradialytic hypotension), and renal recovery. Cox proportional hazards regression models were employed to calculate hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). Pre-specified subgroup analyses also stratified by chronic-kidney-disease status, RRT modality, and the qualifying KDIGO Stage-3 criterion (creatinine, urine output, or both). RESULTS: A total of 5,847 patients with KDIGO Stage 3 AKI were enrolled, of whom 2,156 (37%) underwent RRT. Pre-matching analysis revealed substantially greater disease severity in the RRT group (SOFA score: 12.4 ± 4.2 vs. 8.6 ± 3.8, P < 0.001). Following 1:1 PSM, 1,842 matched pairs were established, with all covariate standardized mean differences (SMDs) below 0.1, indicating satisfactory matching. Within the matched cohort, in-hospital mortality was lower in the RRT group than in the controls (35% vs. 42%, P = 0.002), and the corresponding mortality risk was reduced (HR = 0.78, 95%CI: 0.68-0.89, P < 0.001). The direction and magnitude of the association were consistent across CKD versus non-CKD strata, across the qualifying KDIGO Stage-3 criterion, and across RRT modality, and RRT-related complications were observed but did not exceed rates previously reported in the literature. Subgroup analyses confirmed consistent findings of RRT regardless of sepsis status, mechanical ventilation use, age, or disease severity. CONCLUSION: After the largest confounders for indication were controlled through propensity score matching, RRT was, at a minimum, non-inferior to non-RRT management with respect to in-hospital mortality, and the matched-cohort estimates were consistent with an association with reduced mortality, among patients with severe AKI. These findings should not be read as proof of a causal protective effect, but they support the position that, in appropriately selected critically ill patients with KDIGO Stage 3 AKI - particularly those with refractory hyperkalaemia, severe acidosis, oligo-anuria, or refractory volume overload - RRT should not be withheld on the basis of perceived futility.
Evolution of treatment and oncological outcomes in patients undergoing radical cystectomy: a comparative analysis across two decades at a tertiary center.
Suartz CV, Azevedo MFD, Brito PHS … +9 more , Setoue DND, de Moraes CMT, Sant'Anna PVH, da Silva LGP, Schumacher LB, Galvez VVS, Dener MC, Nahas WC, Ribeiro-Filho LA
BMC Urol · 2026 Jun · PMID 42226192 · Full text
BACKGROUND: Over the last two decades, significant advances in the perioperative management of muscle-invasive bladder cancer, such as enhanced recovery protocols, increased use of neoadjuvant chemotherapy, improved care...
BACKGROUND: Over the last two decades, significant advances in the perioperative management of muscle-invasive bladder cancer, such as enhanced recovery protocols, increased use of neoadjuvant chemotherapy, improved care pathways, and stronger multidisciplinary collaboration, have reshaped surgical outcomes. This study aimed to evaluate the evolution of care and oncological outcomes in patients undergoing radical cystectomy at a Brazilian tertiary cancer center over 20 years. METHODS: We retrospectively analyzed clinical, surgical, and pathological data from patients with bladder cancer who underwent radical cystectomy between January 2005 and April 2025. Patients were stratified into two cohorts according to the year of surgery (2005-2014 vs. 2015-2025). Survival analyses were performed using Kaplan-Meier curves to compare overall survival, cancer-specific survival, and recurrence-free survival between periods. RESULTS: A total of 733 patients were included (mean age, 66.2 years; 69.2% male). An age-adjusted Charlson Comorbidity Index ≥ 3 was present in 90.4%, and preoperative hydronephrosis in 41.5%. Locally advanced disease (pT3-pT4) occurred in 50.9%, lymph node positivity (pN+) in 26.6%, and 34.5% received neoadjuvant chemotherapy. Early complications (< 30 days) occurred in 51.2%, early reoperation in 19.3%, and late complications (30-90 days) in 24.0%, with 33.3% classified as Clavien-Dindo grade ≥ III. On multivariable Cox regression, treatment period remained independently associated with improved overall survival (HR 0.75, 95% CI 0.58-0.97; p = 0.029). Clinical stage was also independently associated with overall survival (overall p = 0.046), with advanced stage increasing the hazard of death (HR 1.48, 95% CI 1.08-2.02; p = 0.015). Kaplan-Meier analysis showed significantly improved overall, cancer-specific, and recurrence-free survival in 2015-2025 versus 2005-2014 (all log-rank p < 0.001). CONCLUSION: Improved survival after radical cystectomy over the last decade reflects advances in perioperative care in the management of bladder cancer patients undergoing radical cystectomy.
Spinal venous hypertension secondary to nutcracker syndrome-a previously unreported cause of congestive myelopathy.
Chang F, Li S, Zhou Y … +5 more , Li K, Tang S, Ma Z, Zhang J, Chen F
BMC Urol · 2026 Jun · PMID 42226056 · Full text
OBJECTIVE: We report a case of myelopathy associated with nutcracker syndrome. Clinical and imaging findings indicate that nutcracker syndrome caused left renal vein stenosis, resulting in spinal venous hypertension. CAS...
OBJECTIVE: We report a case of myelopathy associated with nutcracker syndrome. Clinical and imaging findings indicate that nutcracker syndrome caused left renal vein stenosis, resulting in spinal venous hypertension. CASE PRESENTATION: A 15-year-old girl presented with abnormal sensations in both lower limbs, followed by progressive motor impairment and bowel and bladder dysfunction. Magnetic resonance imaging (MRI) revealed an abnormal signal in the spinal cord at the T12-L1 level. Although she was initially diagnosed with acute transverse myelitis (ATM) and treated with intravenous steroids, cerebrospinal fluid (CSF) analysis showed no signs of inflammation. Further evaluation with Doppler ultrasound and left renal arteriovenous angiography suggested that nutcracker syndrome led to compression of the left renal vein, with aberrant venous branches draining into the spinal venous system. This resulted in spinal venous hypertension and subsequent spinal cord injury. Initial treatment with corticosteroids and immunoglobulins was discontinued due to disease progression. After identifying a left renal vein vascular malformation at an external hospital, balloon dilation of the left renal vein was performed, yielding mild symptomatic relief. Subsequent interventional embolization of the malformed vessels temporarily improved symptoms, though her condition later deteriorated. Ultimately, she underwent laparoscopic robot-assisted external stent placement in the left renal vein at our institution. During the three-month postoperative follow-up, sensory function gradually improved and the clinical condition stabilized. CONCLUSIONS: To our knowledge, this is the first reported case of spinal venous hypertension syndrome secondary to nutcracker syndrome, presenting as myelopathy. We emphasize that in cases of acute myelitis or spinal cord disease of unknown etiology, screening for extramedullary vascular abnormalities-such as left renal artery or vein compression or malformations-should be considered, particularly when inflammatory markers are absent or treatment response is atypical.
Characteristics, treatment patterns, and outcomes of patients with metastatic prostate cancer during 2014-2022 in Pirkanmaa, Finland-an observational study.
Moisander M, Hölsä O, Teittinen K … +4 more , Kysenius K, Kosunen M, Lehmus L, Murtola TJ
Ther Adv Urol · 2026 · PMID 42221687 · Full text
BACKGROUND: The prognosis of patients with metastatic prostate cancer (mPC) has changed profoundly in recent years. However, observational studies are required to understand the real-world outcomes of patients with mPC....
BACKGROUND: The prognosis of patients with metastatic prostate cancer (mPC) has changed profoundly in recent years. However, observational studies are required to understand the real-world outcomes of patients with mPC. OBJECTIVES: In this retrospective single-center observational study, we aimed to describe characteristics, treatments, and outcomes of patients with mPC in Pirkanmaa Hospital District (PHD), Finland, an area with a population of 0.5 million (10% of the Finnish population). DESIGN: The incident patients with mPC treated in PHD during 2014-2022 were identified and stratified into patients with metastatic hormone-sensitive PC (mHSPC) and castration-resistant disease PC (mCRPC). METHODS: Patients with mPC were identified from electronic healthcare data using diagnoses, treatments, procedures, and patient texts. Data on demographics, diagnoses, procedures, treatments, laboratory and pathology tests, and specialized healthcare contacts were collected from specialty care records. Due to changes in treatment practices over time, treatments and outcomes were analyzed in different time periods (mHSPC: 2014-2016 and 2017-2022, mCRPC: 2014-2017 and 2018-2022). RESULTS: In total, 1083 incident patients with mPC were identified, of which 88% received treatment indicated for mPC. Out of the 795 patients with mHSPC, and 558 patients with mCRPC, 84% ( = 668) and 95% ( = 532) received treatment, respectively. The median overall survival (mOS) for all treated patients was 40.1 months. The mOS of treated patients with mHSPC increased from 32.6 months during 2014-2016 to 54.6 months during 2017-2022. CONCLUSION: Since the approval of enzalutamide as a first-line treatment for mCRPC, it has become the most common first-line treatment for mCRPC in PHD. Novel therapeutics, including docetaxel, enzalutamide, and abiraterone, have been adapted into clinical practice and are being used at earlier phases of the disease. Changes in treatment practices correlate with improved outcomes in patients with mHSPC in the PHD area. TRIAL REGISTRATION: ClinicalTrials.gov NCT05701007.
Robot-assisted simple cystectomy for benign disease with medium-term follow-up: a case series.
Spazzapan M, Kam J, Benn E … +9 more , Lutfi B, Folkard S, Furrer MA, Malde S, Thurairaja R, Nair R, Dasgupta P, Sahai A, Khan MS
Ther Adv Urol · 2026 · PMID 42221686 · Full text
BACKGROUND: Robot-assisted cystectomy (RAC) is well established in the management of muscle-invasive or high-grade non-muscle invasive bladder cancer, but its role in benign disease is less well described. This case seri...
BACKGROUND: Robot-assisted cystectomy (RAC) is well established in the management of muscle-invasive or high-grade non-muscle invasive bladder cancer, but its role in benign disease is less well described. This case series represents the largest published experience of RAC for radiation cystitis and the largest series using an intracorporeal urinary diversion technique in this context. OBJECTIVES: To evaluate perioperative outcomes and adverse events following RAC for benign indications, and to compare outcomes between patients with radiation cystitis and other benign conditions. DESIGN: Single-centre, retrospective case series. METHODS: Patients undergoing RAC for benign disease (2013-2024) were identified from a prospectively maintained database and electronic health records. Demographic, perioperative, and postoperative data were analysed using descriptive statistics. Comparative analyses were performed between patients undergoing cystectomy for radiation-related indications and those undergoing surgery for other benign indications using tests, Fisher's exact tests, and Mann-Whitney tests in R. RESULTS: Seventy patients (mean age 65 years; range 23-96) underwent RAC. Indications included radiation cystitis ( = 34; 48.6%), other cystitis ( = 14; 20%), premalignant changes ( = 9; 12.9%), refractory overactive bladder ( = 8; 11.4%), neurogenic bladder ( = 4; 5.7%), and Fowler's syndrome ( = 1; 1.4%). Intracorporeal ileal conduit diversion was performed in 57 cases (81%). Mean operative time was 334 min (range 180-540). Mean blood loss was 326 ml (100-1250) in the radiation group and 300 ml (100-800) in other patients. Mean follow-up was 16 months (1-58). No significant decline in renal function was observed at 1 year in either group ( = 0.8). Complications occurred in 46 patients (66%) within 90 days, with 34% graded Clavien-Dindo III or higher. Fifteen patients (21%) were readmitted within 30 days, and 8 (11%) required further intervention. Limitations include the retrospective design. CONCLUSION: RAC is safe and feasible for benign disease with no observed differences in outcomes between radiation cystitis and other indications in our cohort. Outcomes and complication rates observed are within the published ranges for malignancy-associated radical cystectomy. TRIAL REGISTRATION: Not applicable.
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