BMC Urology[JOURNAL]
Sun
200 papers
Keloids as a rare complication of voluntary medical male circumcision: findings from PEPFAR's notifiable adverse events reporting system.
Davis S, Akom E, Kiggundu V … +17 more , Nabukera S, Thomas A, Simbeye D, Rwabiyago OE, Mmbando S, Kayange A, Fida N, Mandisarisa J, Mhuka T, Msungama W, Kapito M, Matchere F, Maulidi M, Odoyo-June E, Soo L, Juma A, Lucas T
BMC Urol · 2026 Jan · PMID 41545980 · Full text
BACKGROUND: Keloids are rare but challenging complications in penile surgeries, including circumcision. The President’s Emergency Plan for AIDS Relief (PEPFAR) supports voluntary medical male circumcisions (VMMC) for HIV...
BACKGROUND: Keloids are rare but challenging complications in penile surgeries, including circumcision. The President’s Emergency Plan for AIDS Relief (PEPFAR) supports voluntary medical male circumcisions (VMMC) for HIV prevention in sub-Saharan Africa, and has monitored major adverse events through its Notifiable Adverse Event Reporting system (NAER) since 2015, providing unique opportunities to understand keloid epidemiology and risk factors. METHODS: All 2015–2023 NAER keloid cases were reviewed. Variables abstracted included age at VMMC, time course, and case characteristics. Descriptive analysis and Fisher’s exact test of the association between client age (< 15 years vs. ≥ 15 years) and keloids were performed. Systematic literature searches were also conducted on case reports, outcomes and management guidelines, to produce a narrative summary and comparisons between the NAER cases and prior literature. RESULTS: Eleven cases were reported. Clients were < 15 years old in 10/11, with median age 12 years and mean time to diagnosis 1.8 years. Clients aged 10–14 years had a significantly higher risk for keloids compared to those aged 15 and older (p = 0.0004). Case characteristics were similar to those in prior case series, as was management, except that silicone gels or sheeting were not used. Follow-up was too brief to assess outcomes. CONCLUSIONS: Keloids were a rare complication of PEPFAR-supported VMMCs. Keloids were strongly associated with age 10–14 years at circumcision as compared to older age. Programs can remind clients to return to VMMC sites even for late complications, and develop expert referral networks. Silicone gels or sheeting could represent an additional conservative management option.
Day surgery mode of multi-modal image AI fusion targeted transperineal biopsy technique using electromagnetic navigation tracking system under local anesthesia.
Liu Z, Wu J, Li Y … +2 more , Lu Q, Yang Y
BMC Urol · 2026 Jan · PMID 41540385 · Full text
OBJECTIVE: The aim of this study was to explore the safety and feasibility of multi-modal image artificial intelligence (AI) fusion targeted transperineal biopsy (TPB) technique using electromagnetic navigation tracking...
OBJECTIVE: The aim of this study was to explore the safety and feasibility of multi-modal image artificial intelligence (AI) fusion targeted transperineal biopsy (TPB) technique using electromagnetic navigation tracking system (ENTS) in day surgery mode. Furthermore, the integration of rapid paraffin-embedded section (RPES) pathological examination with this advanced TPB technique was assessed to determine its effectiveness in the diagnosis and treatment of prostate cancer. METHOD: The clinicopathological data of 192 consecutive patients who underwent multi-modal image AI fusion targeted TPB technique using ENTS in Hunan Provincial People’s Hospital from January 2023 to March 2024 were retrospectively analyzed. Based on American Society of Anesthesiologists (ASA) classification, the patients were divided into observation group (ASA grade ≥ III) and control group (ASA grade < III). First, multi-parametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) image were fused by AI technology, and 2-core targeted biopsy were performed on target lesion, and then 12-core systematic biopsy were performed. The specimen obtained from targeted biopsy were sent for RPES. The pain and satisfaction scores during TPB and 1 h after TPB, the incidence of perioperative complications and the detection rate of csPCa were recorded. RESULT: The patients with an average age of 69.13 ± 7.89 years. Serum tPSA was 25.51 ± 23.73 ng/mL. Prostate volume was 58.83 ± 38.55 mL. The patients with PI-RADS score of 2, 3, 4 and 5 were 34, 53, 38 and 67, respectively. The detection rate of csPCa was 59.38% (114/192). Based on ASA classification, there were 56 cases in the observation group and 136 cases in the control group. The age of the observation group (72.11 ± 7.14 years) was significantly higher than that of the control group (67.90 ± 7.88 years) (P < 0.01). There were no statistically significant differences in prostate volume, tPSA, PI-RADS score distribution, csPCa detection rates, operation time, pain and anesthesia satisfaction, and complication between the two group (P > 0.05). 158 patients with PI-RADS score ≥ 3 underwent targeted biopsy and systematic biopsy, and the detection rate of csPCa in combined biopsy (67.72%) was higher than that of targeted biopsy (59.49%) and systematic biopsy (65.82%), but there was no statistically significant difference between the three biopsy methods (P > 0.05). For patients with PI-RADS score of 3, 4, and 5, there was no statistically significant difference in the detection rate of csPCa among the difference three biopsy methods (P > 0.05), and the missed detection rate of csPCa in targeted biopsy were 26.32% (5/19), 16.67% (4/24), and 6.25% (4/64), respectively. CONCLUSION: For patients with suspected prostate cancer, day surgery mode of TPB using ENTS under local anesthesia shows good patient tolerance, high surgical safety, and a relatively high csPCa detection rate. RPES with this advanced TPB technique can quickly acquire pathological reports with excellent diagnostic accuracy.
Clinical utility of cell-free urine miR-93-5p, miR-191-5p, miR-31-5p for invasive urothelial carcinoma detection and immune signature-based subtyping.
Özden SB, Kalaycı A, Gürses İ … +4 more , Özdemir F, Sertbudak İ, Kuzucu F, Demirdağ Ç
BMC Urol · 2026 Jan · PMID 41535800 · Full text
PURPOSE: This study aimed to explore the potential value of urinary cell-free microRNA (miR)-93-5p, miR-191-5p, and miR-31-5p levels in the non-invasive prediction of basal-like and luminal-like invasive urothelial carci...
PURPOSE: This study aimed to explore the potential value of urinary cell-free microRNA (miR)-93-5p, miR-191-5p, and miR-31-5p levels in the non-invasive prediction of basal-like and luminal-like invasive urothelial carcinoma immune signature phenotypes according to the molecular classification of bladder cancer, by comparing their expression in patients and healthy controls. METHODS: The study included morning urine samples from 49 bladder cancer patients and 43 controls. A quantitative image-based immunohistochemical analysis classified tumor cases into basal-like and luminal-like subtypes. Quantitative real-time PCR (qRT-PCR) was used to measure cell-free miR-93-5p, miR-191-5p, and miR-31-5p expression levels in urine. RESULTS: MiR-191-5p was significantly downregulated in bladder cancer patients compared to healthy controls (p < 0.001), with a 24-fold decrease. Notably, miR-191-5p levels were markedly lower in the luminal-like subtype relative to the control group (p < 0.001). In contrast, miR-93-5p was significantly upregulated in the basal-like subtype, showing a 4.15-fold increase compared to controls (p < 0.001). Elevated levels of miR-93-5p were also observed in high-grade tumors (3.4-fold, p = 0.004), in tumors exhibiting necrosis (3.4-fold, p < 0.001), and in the presence of carcinoma in situ (CIS) (2.6-fold, p = 0.02). Furthermore, miR-93-5p levels showed a positive correlation with tumor size (r = 0.41, p < 0.001). In this exploratory cohort, miR-93-5p also demonstrated strong discriminatory performance in identifying CK5/6-positive tumors, with a receiver operating characteristic (ROC) curve cut-off value of 1.57 for 2^ΔΔCT value. CONCLUSIONS: In this single-center, exploratory study, urinary cell-free miR-93-5p and miR-191-5p showed potential utility as non-invasive biomarkers for rapid molecular subtype identification in bladder cancer. miR-93-5p was associated with basal-like (aggressive) tumor features, while miR-191-5p was inversely associated with invasive urothelial carcinoma. miR-31-5p appears to serve as a complementary marker, especially in cases of CIS.
Comparison of intravesical Bacillus Calmette-Guérin and chemohyperthermia with mitomycin C in with high-risk non-muscle-invasive bladder cancer: a critical assesment focusing on the quality of life and adverse events.
Ilki FY, Bülbül E, Topçu YK … +3 more , Cinar O, Kocabıyık C, Bedir S
BMC Urol · 2026 Jan · PMID 41535790 · Full text
OBJECTIVE: This study aimed to compare the effects of intravesical Bacillus Calmette-Guérin (BCG) and chemohyperthermia (CHT) with mitomycin C (MMC) therapy on symptom burden, recurrence, and quality of life in patients...
OBJECTIVE: This study aimed to compare the effects of intravesical Bacillus Calmette-Guérin (BCG) and chemohyperthermia (CHT) with mitomycin C (MMC) therapy on symptom burden, recurrence, and quality of life in patients with high-risk non–muscle-invasive bladder cancer (NMIBC). METHODS: A total of 116 male patients with high-risk NMIBC were included, comprising 52 treated with BCG and 64 treated with CHT-MMC. Symptom severity was evaluated using the International Prostate Symptom Score (IPSS) and the Overactive Bladder Questionnaire (OAB-V8) before and after treatment. Post-treatment adverse events such as dysuria, hematuria, and pollakiuria were recorded. Quality of life was assessed using the Short Form-12 (SF-12) Health Survey, including the physical (PCS) and mental component summary (MCS) scores. Recurrence rates were monitored during a 24-month follow-up period. RESULTS: Following treatment, symptom scores (IPSS and OAB-V8) were significantly worsened in the BCG group compared to the CHT-MMC group (p < 0.01). Dysuria occurred in 84.6% of patients in the BCG group and in 46.2% of those in the CHT-MMC group (p = 0.054). Hematuria was observed in 43.8% and 12.5% of patients in the BCG and CHT-MMC groups, respectively (p = 0.095). The mean PCS score was significantly lower in the BCG group than in the CHT-MMC group (43.9 ± 11.0 vs. 54.9 ± 6.3, p = 0.008), whereas there was no statistically significant difference in MCS scores between the two groups (p = 0.145). Disease recurrence was detected in 22 of 52 patients (42.3%) in the BCG group and in 38 of 64 patients (59.4%) in the CHT-MMC group (p = 0.467). CONCLUSION: Intravesical chemohyperthermia with mitomycin C (CHT-MMC) was associated with a more favorable symptom profile and superior physical quality of life compared to BCG, while no statistically significant difference was observed in recurrence rates. These results indicate that intravesical CHT-MMC may represent a well-tolerated and effective therapeutic alternative for high-risk NMIBC patients who are intolerant to or have contraindications for BCG therapy.
Comparing the clinical accuracy of urine exfoliated cell examination and fluorescence in situ hybridization in the diagnosis of upper urinary tract urothelial carcinoma.
Wang C, Liu Y, Zhang C … +4 more , Wang C, Wu J, Xiao F, Jin J
BMC Urol · 2026 Jan · PMID 41527092 · Full text
BACKGROUND: To compare the effectiveness and clinical accuracy of fluorescence in situ hybridization (FISH) and urine exfoliated cytology in the evaluation of upper urinary tract urothelial cell carcinoma (UTUC). METHODS...
BACKGROUND: To compare the effectiveness and clinical accuracy of fluorescence in situ hybridization (FISH) and urine exfoliated cytology in the evaluation of upper urinary tract urothelial cell carcinoma (UTUC). METHODS: 60 patients with suspected UUT-UC admitted to our hospital from May 2021 to May 2023 were selected. All patients underwent FISH and urine exfoliated cytology, and a ureteroscopy pathological biopsy was performed. Using pathological biopsy results as the “gold standard”, we analyzed the compliance rate of FISH and urine exfoliated cytology to evaluate UTUC. RESULTS: Among 60 patients with suspected UTUC, 52 cases were confirmed positive by pathological biopsy, and 8 cases were negative. The positive detection rate of FISH was 90.38%, which was higher than 71.15% of urine exfoliated cytology (P < 0.05). The coincidence rate of urine exfoliated cytology in assessing high-grade UTUC tumors was 76.67%, and the discrepancy rate was 23.33%; the coincidence rate in assessing low-grade tumors was 63.64%, and the discrepancy rate was 36.36%. The coincidence rate of FISH in assessing high-grade UTUC tumors was 93.33%, and the discrepancy rate was 6.67%; the coincidence rate in assessing low-grade tumors was 86.36%, and the discrepancy rate was 13.64%. CONCLUSION: Compared with urine exfoliated cytology, FISH demonstrated higher diagnostic accuracy for the detection of UTUC and greater accuracy in UTUC classification.
Comparative analysis of EAU, AUA, and NCCN guidelines for the management of non-muscle invasive bladder cancer.
Aydın ME, Aykaç A, Kaya C … +1 more , Sungur M
BMC Urol · 2026 Jan · PMID 41526868 · Full text
BACKGROUND: This study aimed to systematically compare the most recent guidelines from the European Association of Urology (EAU, 2025), American Urological Association (AUA, 2024), and National Comprehensive Cancer Netwo...
BACKGROUND: This study aimed to systematically compare the most recent guidelines from the European Association of Urology (EAU, 2025), American Urological Association (AUA, 2024), and National Comprehensive Cancer Network (NCCN, 2025) for the management of non-muscle invasive bladder cancer (NMIBC). The primary objective was to assess the degree of concordance and identify sources of divergence across 32 predefined clinical decision domains. MATERIALS AND METHODS: This guideline concordance study was conducted according to PRISMA 2020 recommendations, evaluating full-text versions of the latest EAU, AUA, and NCCN guidelines. Thirty-two clinical domains encompassing the diagnostic, therapeutic, and follow-up aspects of NMIBC management were pre-defined based on literature review and expert consensus. Two independent reviewers classified each domain for each guideline as full concordance, partial concordance, or discordance, with discrepancies resolved by a third reviewer. Inter-guideline agreement was quantified using Cohen's and Fleiss' kappa coefficients. RESULTS: Among the 32 domains analyzed, full concordance was identified in 19 domains (59.4%), partial concordance in 12 domains (37.5%), and discordance in 1 domain (3.1%). Inter-guideline reliability was high, with Cohen's kappa values ranging from 0.83 to 0.94 across pairs and an overall Fleiss' kappa of 0.74, indicating substantial agreement among the three guidelines. Clinically meaningful differences were mainly related to risk-stratification criteria, the management of BCG-unresponsive disease, the selective use of urinary biomarkers, and the endorsement of conservative strategies for recurrent low-grade tumors. CONCLUSION: Current international guidelines for NMIBC are highly consistent across the majority of clinical decision domains, providing a strong framework for evidence-based care. Residual differences reflect evolving evidence, regulatory environments, and the pace of integration of new diagnostics and therapeutics. Continued harmonization efforts and regular guideline updates are necessary to further optimize global NMIBC management.
Neoadjuvant immunotherapy combined with HER2-targeted antibody-drug conjugate in bladder urothelial carcinoma: a case report.
Guo Z, Wang G
BMC Urol · 2026 Jan · PMID 41514418 · Full text
BACKGROUND: Bladder urothelial carcinoma (UC) represents a prevalent and clinically aggressive malignancy. For cisplatin-intolerant patients, there remains an urgent need to investigate alternative therapeutic regimens....
BACKGROUND: Bladder urothelial carcinoma (UC) represents a prevalent and clinically aggressive malignancy. For cisplatin-intolerant patients, there remains an urgent need to investigate alternative therapeutic regimens. This case report describes the application of combined immunotherapy and HER2-targeted antibody–drug conjugate (ADC) therapy in a patient with gemcitabine plus cisplatin (GC regimen) intolerant bladder UC. CASE PRESENTATION: A 66-year-old female patient was diagnosed with human epidermal growth factor receptor 2 (HER2)-positive (immunohistochemistry 2+/3+) bladder UC (T3N0M0). Initial gemcitabine-cisplatin chemotherapy was discontinued due to severe adverse effects. The patient subsequently received four cycles of tislelizumab, an anti-programmed cell death protein-1 monoclonal antibody and five cycles of disitamab vedotin, a HER2-targeted ADC, as neoadjuvant therapy. The treatment was well tolerated, with mild adverse events. Following treatment, the patient underwent laparoscopic radical cystectomy with ileal neobladder reconstruction. The pathological diagnosis revealed treatment-related changes consistent with pathological complete response (pCR), with no recurrence observed during the 9-month postoperative follow-up. CONCLUSION: This case demonstrates that neoadjuvant immunotherapy combined with HER2-targeted ADC therapy achieved pCR with a favourable safety profile in a GC regimen-intolerant patient with HER2-positive bladder UC. This result supports the further evaluation of this approach in both clinical studies and real-world practice.
A feasibility study of a novel irrigation technique for reducing intrapelvic pressure during ureterorenoscopy using conventional devices.
Sugihara N, Kono R, Sogabe H … +11 more , Saiki K, Arai H, Arai O, Onishi T, Kakuda T, Hara K, Watanabe R, Miura N, Ozawa A, Iseda T, Saika T
BMC Urol · 2026 Jan · PMID 41514222 · Full text
PURPOSE: Ureterorenoscopy (URS) is a widely accepted approach for managing upper urinary tract stones, including renal calculi measuring > 20 mm. However, an elevated intrapelvic pressure (IPP) during URS can lead to inf...
PURPOSE: Ureterorenoscopy (URS) is a widely accepted approach for managing upper urinary tract stones, including renal calculi measuring > 20 mm. However, an elevated intrapelvic pressure (IPP) during URS can lead to infectious and procedural complications. We developed a simple irrigation technique and evaluated its efficiency in reducing IPP during URS. METHODS: In this technique, a 14/16-Fr ureteral access sheath (UAS) was advanced to the ureteropelvic junction or distal to the stone. A 4.7-Fr single-J ureteral stent was inserted through the UAS, with the tip placed in the renal pelvis or upper calyx. The stent enabled continuous fluid outflow and reduced the IPP. We defined this technique as the “Continuous Alternative Reduction of the intrapelvic Pressure” (CARP) system. The study comprised: (1) IPP measurements in a representative case comparing conventional URS and the CARP system, and (2) a retrospective analysis of patients treated using the CARP system between June 2020 and October 2024, excluding those with staghorn calculi. RESULTS: The CARP system significantly reduced the IPP. In the conventional URS setup, pressure exceeded 100 cmH₂O during flushing, whereas the CARP system maintained pressures below 25 cmH₂O. Overall, 34 renal and 45 ureteral stones were analyzed. The median stone burden was 20.5 mm for renal and 18.2 mm for ureteral stones. The stone-free rates were 97.1% for renal and 97.8% for ureteral stones. Postoperative fever occurred in 5.1% of the patients. No UAS-related ureteral strictures were observed. CONCLUSION: This technique can be easily implemented using existing devices and has demonstrated favorable outcomes with minimal complications.
Clinical reasoning with machines: evaluating the interpretive depth of AI in urological case assessments.
Taşkıran AT, Balık AY, Başaran E … +2 more , Baba D, Kayıkçı MA
BMC Urol · 2026 Jan · PMID 41507902 · Full text
BACKGROUND: Large language models (LLMs) are increasingly utilized as decision-support tools in medicine. However, their clinical reliability and applicability remain uncertain. This study compared ChatGPT-3.5, ChatGPT-4...
BACKGROUND: Large language models (LLMs) are increasingly utilized as decision-support tools in medicine. However, their clinical reliability and applicability remain uncertain. This study compared ChatGPT-3.5, ChatGPT-4o, and Gemini 1.0 Pro in responding to standardized urological clinical scenarios evaluated by blinded experts. METHODS: This observational cross-sectional study included 75 urology specialists categorized by experience (< 10 years vs. ≥ 10 years). Participants independently and blindly rated anonymized AI-generated responses for 10 common urological cases using a 5-point Likert scale across four predefined domains: accuracy, reliability, clinical applicability, and interpretive depth. Normality was assessed with the Shapiro–Wilk test, and ANOVA or Kruskal–Wallis tests were used as appropriate, followed by post-hoc pairwise analyses. Inter-rater reliability was calculated using Cronbach’s α and Fleiss’ κ. Spearman correlation coefficients were computed to examine associations among rating domains. RESULTS: ChatGPT-4o achieved the highest mean scores across all domains, followed by Gemini 1.0 Pro and ChatGPT-3.5. Performance differences were statistically significant for all parameters (p < 0.05), with the largest gaps observed in accuracy (4.4 ± 0.48 vs. 4.0 ± 0.52 vs. 3.7 ± 0.56) and clinical applicability (4.2 ± 0.49 vs. 3.8 ± 0.51 vs. 3.5 ± 0.55). A moderate positive correlation was observed between accuracy and reliability (r = 0.50), while the previously reported negative correlation between reliability and interpretive depth was corrected to r = − 0.18, indicating only a weak inverse relationship. Inter-rater agreement was high (Cronbach’s α = 0.84; Fleiss’ κ = 0.72). CONCLUSION: Newer-generation large language models, particularly ChatGPT-4o, showed higher performance scores in terms of accuracy and clinical applicability in standardized urological decision-support scenarios. However, these findings should be interpreted with caution and require confirmation through repeated-measures or mixed-model analyses as well as validation in real-world clinical settings. Ongoing benchmarking of evolving AI systems remains important to monitor longitudinal improvements while ensuring safety, reliability, and appropriate clinical use.
Post Fournier gangrene raw areas in the penis or scrotum: the role of intense pulsed light and radiofrequency in conservative treatment.
Elmelegy N, Elghazaly M, Nader D
BMC Urol · 2026 Jan · PMID 41507891 · Full text
BACKGROUND: For infected wounds, including clostridial myonecrosis, necrotizing soft tissue infections, and Fournier's gangrene, hyperbaric oxygen therapy (HBOT) is advised; however, tension pneumothorax and gas emboli m...
BACKGROUND: For infected wounds, including clostridial myonecrosis, necrotizing soft tissue infections, and Fournier's gangrene, hyperbaric oxygen therapy (HBOT) is advised; however, tension pneumothorax and gas emboli may occur during the process. Other instances of relative contraindications include illnesses like asthma and chronic obstructive lung disease. We can use radio frequency and strong pulsed light in our research without having to worry about these kinds of issues and could have a significant impact on improving treatment outcomes. OBJECTIVE: To assess how well intensely pulsed light and radiofrequency work for treating the aftereffects of post-Fournier's gangrene. PATIENTS AND METHOD: Intense pulsed light and radiofrequency sessions were used to treat sixteen male patients with isolated penile or scrotal post-Fournier's gangrene raw areas. RESULTS: Twelve patients (75%) had an excellent satisfaction rate, and four (25%) rated it as good. No fair or poor results were documented. CONCLUSION: We are unable to make significant conclusions because of the small number of patients; however, since E-light is a simple, effective, and affordable treatment with good outcomes and no side effects, we advise more research on its application in the treatment of post-Fournier's gangrene isolated raw areas of the scrotum and penis.
MXRA8, a key palmitoylation-related gene, promotes bladder cancer progression via remodeling tumor microenvironment and predicts poor prognosis.
Wang H, Xiong Y, He T … +4 more , He M, Deng J, Song D, Wang Z
BMC Urol · 2026 Jan · PMID 41507856 · Full text
OBJECTIVE: The objective of this study was to comprehensively characterize the expression profiles and prognostic significance of palmitoylation-related genes (PRGs) in bladder cancer (BLCA). METHODS: Transcriptomic, cli...
OBJECTIVE: The objective of this study was to comprehensively characterize the expression profiles and prognostic significance of palmitoylation-related genes (PRGs) in bladder cancer (BLCA). METHODS: Transcriptomic, clinical, and somatic mutation data of BLCA patients were obtained from The Cancer Genome Atlas (TCGA) and the GEO dataset (GSE13507), and batch effects were corrected using the ComBat method. Consensus clustering was performed to identify PRG-related molecular subtypes. Prognostic differentially expressed genes (DEGs) were further used for gene subtyping, and a PRG-based prognostic risk model was constructed by applying the least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression. CIBERSORT assessed immune infiltration, while scRNA-seq data from Tumor Immune Single-cell Hub (TISCH) analyzed core gene expression in cell clusters. The biological function of the core gene was validated by Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR), Western blotting, wound-healing, colony-formation, and EdU assays. RESULTS: Two distinct PRG-related molecular subtypes and two gene subtypes were identified. The nine core genes (including MXRA8) showed robust predictive performance (AUC > 0.7 for 1-, 3-, and 5-year overall survival) and was incorporated into a nomogram along with clinical parameters. MXRA8 was highly expressed in BLCA tissues at both transcript and protein levels and predominantly expressed in fibroblast and myofibroblast clusters. Functionally, silencing MXRA8 significantly suppressed BLCA cell proliferation, migration, and invasion. CONCLUSIONS: The PRG-based risk score serves as a robust and clinically applicable tool for prognostic evaluation and predicting chemotherapy response. Furthermore, MXRA8 may serve as a potential molecular hub for developing precision medicine–oriented therapeutic strategies in BLCA.
Readability and quality assessment of AI-powered chatbot responses to overactive bladder patient questions: a comparative study.
Deger M, Ates T, Yilmaz IO … +5 more , Arıkan MG, Sukur IH, Ok F, Akdogan N, Izol V
BMC Urol · 2026 Jan · PMID 41501759 · Full text
INTRODUCTION: Overactive bladder (OAB) is a common urological condition affecting millions of people worldwide, significantly reducing their quality of life. Patient compliance and active participation in disease managem...
INTRODUCTION: Overactive bladder (OAB) is a common urological condition affecting millions of people worldwide, significantly reducing their quality of life. Patient compliance and active participation in disease management are critical to achieving successful outcomes. This study aims to understand the potential role of AI-assisted chatbots in educating patients with OAB and their impact on health literacy. METHODS: We compared responses from four AI chatbots (ChatGPT, DeepSeek, Claude, and Gemini) to 16 standardized questions from the AUA Overactive Bladder Patient Guide. Two board-certified urologists independently evaluated responses using Ensuring Quality Information for Patients (EQIP) tool and Google E-E-A-T principles. RESULTS: Inter-rater reliability was excellent (ICC = 0.97 for EQIP, κ = 0.89 for E-E-A-T). A significant difference was found between chatbots in terms of readability scores (Gunning Fox Index p = 0.008, Flesch-Kincaid Grade Level p < 0.001), with all responses requiring education levels above the recommended 6th-8th grade. However, significant differences emerged in information quality (EQIP, p < 0.001; E-E-A-T, p < 0.001). Gemini demonstrated superior performance in both EQIP (60.2 ± 6.92) and E-E-A-T scores (13.5) compared to all other chatbots. CONCLUSION: AI chatbots show potential for patient education but produce content with readability levels too complex for general audiences. Significant quality variations exist between models. These findings emphasize the need for collaboration between healthcare professionals and AI developers to create more accessible, reliable health information systems.
The efficacy of super-lubricous Foley catheters in indwelling catheterization: a randomized controlled trial.
Zhu YL, Liao M, Luo Y … +2 more , Li ZY, Li K
BMC Urol · 2026 Jan · PMID 41501738 · Full text
OBJECTIVE: This randomized controlled trial evaluated the clinical efficacy of super-lubricous Foley catheters in reducing urethral complications during indwelling catheterization. Focusing on addressing friction-induced...
OBJECTIVE: This randomized controlled trial evaluated the clinical efficacy of super-lubricous Foley catheters in reducing urethral complications during indwelling catheterization. Focusing on addressing friction-induced injuries, the study assessed four outcomes: 1) urethral adverse reactions; 2) urethral trauma and inflammatory responses; 3) patient comfort; and 4) post-removal voiding symptoms. METHODS: A total of 114 patients from a tertiary hospital (December 2023-June 2024) were randomly allocated into two arms: 57 individuals in the experimental arm were treated with super-lubricous Foley catheters, whereas the same number in the control arm received conventional catheters. Primary outcomes included bladder irritation and urethral pain. Secondary outcomes encompassed urethral injury (red blood cells and epithelial cells), inflammation (white blood cells), comfort metrics (activity restriction, sleep disturbance, anxiety), and voiding parameters (dysuria, urinary hesitation, incomplete bladder emptying and lower abdominal pain). RESULTS: The baseline data revealed no statistically meaningful differences between the two groups. (all P > 0.05). The experimental group demonstrated significantly lower overall rates of bladder irritation (31.6% vs. 50.9%, P < 0.05) and urethral pain during catheterization (14.0% vs. 31.6%, P < 0.05). Notably, urinary epithelial cells (median 6 vs. 13.5/HP) and leukocytes (31 vs. 81/μL) were reduced in the experimental group (P < 0.05). Activity restriction rates decreased significantly (42.1% vs. 68.4%, P < 0.05), and first void volume improved (200 vs. 150 mL, P < 0.05). There were no meaningful differences between groups in the occurrence of the four urination-related symptoms-including dysuria, urinary hesitation, incomplete bladder emptying, and lower abdominal pain (all P > 0.05). CONCLUSION: Super-lubricous Foley catheters effectively mitigate bladder irritation, urethral trauma, and inflammation while enhancing patient mobility. However, they show limited efficacy in alleviating post-removal voiding dysfunction. These findings support the clinical adoption of super-lubricous Foley catheters for reducing catheterization-related complications. TRIAL REGISTRATION: This study was a randomized controlled trial registered at Chinese Clinical Trial Registry (ChiCTR2300078483, https://www.chictr.org.cn/ ) on 11 December 2023.
Risk factors for steinstrasse formation after extracorporeal shock wave lithotripsy for renal pelvic stones.
Aydamirov M, Karkin K, Gurlen G … +8 more , Alma E, Altunkol A, Kaplan E, Aksay B, Akbulut G, Sigva H, Vuruskan E, Tunckiran MA
BMC Urol · 2026 Jan · PMID 41495712 · Full text
BACKGROUND: This study aimed to identify predictive factors for the formation of steinstrasse following extracorporeal shock wave lithotripsy (SWL) in patients with medium-sized (10-20 mm) renal pelvic stones. METHODS: T...
BACKGROUND: This study aimed to identify predictive factors for the formation of steinstrasse following extracorporeal shock wave lithotripsy (SWL) in patients with medium-sized (10-20 mm) renal pelvic stones. METHODS: This retrospective cohort study, data of 718 patients who underwent SWL for urinary tract stones were analyzed and single, unilateral, radio-opaque renal pelvic stones were included in the study. Patient age, sex, stone side, shape (round/non-round), size, surface area (SA), and presence of hydronephrosis were recorded. Patients were divided into two groups depending on the presence of steinstrasse: Group 1 (with steinstrasse) and Group 2 (without). Demographic, clinical, and radiological parameters were compared between the groups. RESULTS: The mean age of the patients was 50.8 ± 11.2 years. The average number of SWL sessions was 2 (range 1-4). Group 1 included 12 patients (23.1%), while Group 2 comprised 40 patients (76.9%). The mean SA in Group 1 was significantly higher than in Group 2 (145.43 vs. 111.69 mm; p = 0.044). Round stones were more frequently observed in Group 1, whereas non-round stones predominated in Group 2 (83.3% vs. 62.5%, respectively; p = 0.008). The overall SWL success rate was determined as 76.9%. Logistic regression analysis revealed that round stones increased the risk of steinstrasse by 8.333 times (OR = 8.333, 95% CI = 1.604-43.288, p = 0.012). CONCLUSIONS: SA was higher in patients who developed steinstrasse. Since the likelihood of steinstrasse formation is elevated in medium-sized round renal pelvic stones, pre-stenting may be appropriate.
From ChatGPT to DeepSeek: assessing the accuracy and readability of AI-generated erectile dysfunction responses.
Demirhan K, Erdik A, Cimen HI … +2 more , Kose O, Saglam HS
BMC Urol · 2026 Jan · PMID 41485076 · Full text
BACKGROUND: This study aims to compare responses generated by DeepSeek, a new large language model, and ChatGPT to erectile dysfunction (ED)–related questions. METHODS: The study was conducted by posing online queries to...
BACKGROUND: This study aims to compare responses generated by DeepSeek, a new large language model, and ChatGPT to erectile dysfunction (ED)–related questions. METHODS: The study was conducted by posing online queries to both ChatGPT-4o (OpenAI, United States) and DeepSeek V3 (Hangzhou DeepSeek Artificial Intelligence, China). The most frequently asked questions about ED were identified using Google Trends. The responses from both artificial intelligence (AI) were evaluated by three board-certified urologists, who rated their accuracy on a scale of 1 to 4. Readability was assessed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Score (GFS). RESULTS: DeepSeek V3 received a significantly higher total reviewer score compared to ChatGPT-4o (4 (IQR 1) vs. 3 (IQR 1); p = 0.016), and its responses contained more words on average (233 (IQR 113) vs. 139 (IQR 99), p = 0.004). While no significant difference was observed in FRES (-5.7 (IQR 17.5) vs. -10.1 (IQR 17.7), p = 0.140), both FKGL ( 16.5 (IQR 1.9) vs. 17.9 (IQR 2.7), p = 0.034) and GFS (18.8 (IQR 4.9) vs.20.6 (IQR 5.8), p = 0.016) scores were significantly lower for DeepSeek-V3, indicating superior readability. CONCLUSION: While both ChatGPT-4o and DeepSeek-V3 generated fluent and readable responses, DeepSeek-V3 consistently provided longer, more comprehensive, and highly readable answers,accompanied by higher expert-rated accuracy to ED-related questions. These findings highlight the potential of newer AI models—driven by rapid competitive advancements—to effectively address patient inquiries in sensitive medical domains like ED.
Evaluation of large language models in assigning PI-RADS v2.1 categories for prostate MRI reports.
Akdal Dolek B, Besler MS
BMC Urol · 2026 Jan · PMID 41484874 · Full text
BACKGROUND: This study aimed to evaluate the performance of large language models (LLMs) in classifying prostate MRI reports according to the Prostate Imaging–Reporting and Data System (PIRADS) version 2.1, and to valida...
BACKGROUND: This study aimed to evaluate the performance of large language models (LLMs) in classifying prostate MRI reports according to the Prostate Imaging–Reporting and Data System (PIRADS) version 2.1, and to validate their use in supporting clinical decisions in prostate cancer treatment. METHODS: This retrospective study included 146 patients. Four LLMs — GPT-4o, GPT-o1, Google Gemini 1.5 Pro and Google Gemini 2.0 Experimental Advanced — were tested on standardised, structured prostate MRI reports. A two-radiologist consensus reference standard was used to compare model performance. Agreement was measured using weighted Cohen’s kappa, and accuracy and F1 scores were calculated for three PI-RADS risk groups: low (1–2), intermediate (3) and high (4–5). RESULTS: Performance varied by model. GPT-o1 achieved the highest level of agreement with radiologists (κ = 0.867), followed by GPT-4o (κ = 0.743), Gemini 1.5 Pro (κ = 0.728) and Gemini 2.0 Experimental Advanced (κ = 0.664). GPT-o1 achieved the highest F1 scores for the low-risk (0.93) and high-risk (1.00) groups, demonstrating moderate performance for the PI-RADS 3 group (0.75). All models showed weak performance for PI-RADS 3 (F1 range: 0.54–0.75). Most importantly, none of the models produced invalid results outside the target PI-RADS 1–5 range. CONCLUSION: LLMs show potential for automating PI-RADS classification from MRI reports, with GPT-o1 demonstrating the best overall performance. However, their failure in PI-RADS 3 lesions indicates that multicentre validation, larger datasets and multimodality integration are needed before they can be used clinically for prostate cancer diagnosis and urological decision-making. TRIAL REGISTRATION: Not applicable. This retrospective study did not involve a clinical trial.
Plasma presepsin as a predictor of mortality in patients with UTI-related severe infection: a single-center retrospective study.
Lee JW, Song D, Yoon SH … +8 more , Yun SR, Hwang WM, Kim YK, Hur SH, Lee JK, Kwon SJ, Shin J, Park Y
BMC Urol · 2025 Dec · PMID 41469631 · Full text
BACKGROUND: This study aimed to evaluate whether plasma presepsin levels are a more reliable predictor of mortality than traditional infection biomarkers in patients with urinary tract infection (UTI)-related severe infe...
BACKGROUND: This study aimed to evaluate whether plasma presepsin levels are a more reliable predictor of mortality than traditional infection biomarkers in patients with urinary tract infection (UTI)-related severe infection. METHODS: This single-center retrospective study evaluated 69 patients with UTI-related severe infection admitted to the emergency department between May 2022 and August 2023. Data on vital signs, plasma presepsin levels, procalcitonin (PCT) levels, C-reactive protein (CRP) levels, white blood cell (WBC) count, and other laboratory values at admission were collected. The values of presepsin, PCT, CRP, and WBC count for predicting 28-day mortality were analyzed. Survivors and non-survivors were propensity score-matched in a 2:1 ratio based on age, sex, and estimated glomerular filtration rate. RESULTS: In the overall cohort, presepsin showed the highest area under the receiver operating characteristic curve (AUROC) of 0.716 for predicting 28-day mortality, surpassing that of PCT (0.641), CRP (0.488), and WBC count (0.433). Presepsin levels were independently associated with increased 28-day mortality risk (hazard ratio, 1.026; p = 0.008). In the matched cohort, presepsin levels showed the highest AUROC (0.660), followed by PCT (0.584), CRP (0.496), and WBC count (0.436). CONCLUSIONS: Presepsin levels were independently associated with increased 28-day mortality risk; this may be a valuable biomarker for identifying high-risk patients with UTI-related severe infection.
Study on causes of death and influencing factors in hemodialysis patients with End-Stage renal disease.
Huang J, Li Y, Shen S … +2 more , Yu L, Sun Q
BMC Urol · 2025 Dec · PMID 41462180 · Full text
BACKGROUND: Mortality remains high among patients with end-stage renal disease (ESRD) on maintenance hemodialysis despite advances in dialysis technology. This study aimed to investigate the causes of death and identify...
BACKGROUND: Mortality remains high among patients with end-stage renal disease (ESRD) on maintenance hemodialysis despite advances in dialysis technology. This study aimed to investigate the causes of death and identify factors associated with survival in a Chinese hemodialysis population. METHODS: We conducted a single-center retrospective cohort of deceased maintenance hemodialysis patients. Eligible patients had received thrice-weekly hemodialysis for ≥ 3 months prior to death; peritoneal dialysis, transplant during follow-up, and incomplete records were excluded. Subgroup analyses compared survival by age (< 60, 60-70, 70-80, > 80 years), dialysis duration (< 1, 1-5, 5-10, > 10 years), and sex using Kaplan-Meier curves with log-rank tests. Cox models assessed factors associated with all-cause mortality; logistic regression evaluated correlates of cardiovascular death. RESULTS: A total of 194 patients were included. The mean age was 71.35 ± 13.05 years, with males accounting for 60.8%. Leading causes of death were cardiovascular (29.9%), cerebrovascular (19.6%), and infection (16.5%). Female sex and longer dialysis vintage showed better survival (log-rank p = 0.048 and p < 0.0001, respectively). The 60-70 years age group demonstrated the best survival profile (p = 0.023). Among patients with documented comorbidity data, hypertension was present in 73/73 (100%) and diabetes mellitus in 82/82 (100%). Higher LDL-C and pre-dialysis hyperkalemia were associated with cardiovascular death (OR 1.37, 95% CI 1.10-1.72, p = 0.005 and OR 2.19, 95% CI 1.08-4.45, p = 0.031, respectively), while lower albumin and higher CRP were associated with infection-related death (p = 0.037 and p = 0.024, respectively). CONCLUSIONS: Cardiovascular and cerebrovascular diseases remain the leading causes of death in hemodialysis patients. Sex, age, serum albumin, LDL-C, and inflammatory markers were associated with survival outcomes. Understanding these associations may help develop targeted interventions to improve survival in hemodialysis patients.
Factors predicting ureteral stenosis after transurethral resection of the ureteral orifice: a two-center, retrospective clinical study.
Güner E, Şam E, Fakir AE … +5 more , Güneren MS, Turan A, Koçakgöl H, Cinislioğlu AE, Akkaş F
BMC Urol · 2025 Dec · PMID 41457214 · Full text
PURPOSE: We aimed to evaluate the factors predictive of ureteral stenosis after orifice resection and to determine whether ureteral stenting is effective in preventing it. METHODS: The data of patients who underwent tran...
PURPOSE: We aimed to evaluate the factors predictive of ureteral stenosis after orifice resection and to determine whether ureteral stenting is effective in preventing it. METHODS: The data of patients who underwent transurethral resection of bladder tumor (TUR-BT) in the clinics of two tertiary centers between June 2020 and January 2024 were retrospectively reviewed. Patients who underwent orifice resection due to tumor involvement of the ureteral orifice or too close to it were included in the study. During follow-up, cystoscopy ± diagnostic ureterorenoscopy was performed in patients with hydronephrosis. Ureteral stenosis was defined as a narrowing that precluded the passage of the ureterorenoscope and where no tumoral lesion was detected at the orifice site. RESULTS: A total of 96 patients were included in the study. A D-J stent was inserted in 49 (51%) of the patients following TUR-BT. At a median follow-up of 30 months, metachronous upper urinary tract urothelial carcinoma developed in 8 (8.3%) patients and ureteral stenosis in 11 (11.5%) patients. Ureteral stenosis developed in 2 (4.1%) patients who underwent D-J stent placement versus 9 (19.1%) patients who did not, a difference that was significant. Age, tumor diameter, presence of carcinoma in situ (CIS), and bladder tumor progression rate were significantly higher in patients with ureteral stenosis. In multivariate logistic regression analysis, only the presence of CIS was identified as an independent predictor of ureteral stenosis. CONCLUSION: Although the rate of ureteral stenosis was significantly lower in patients who underwent ureteral stenting, only the presence of CIS was identified as an independent predictor of ureteral stenosis.
Serum PSA levels fluctuations in patients with non-muscle-invasive bladder cancer (NMIBC) undergoing BCG therapy: a prospective study.
Ahmadi SP, Sadabadi F, Khoshbin B … +1 more , Sheikhi Z
BMC Urol · 2025 Dec · PMID 41455940 · Full text
BACKGROUND: Intravesical bacillus Calmette–Guérin (BCG) therapy is the standard adjuvant treatment for intermediate-high risk non–muscle-invasive bladder cancer (NMIBC). Transient elevations in prostate-specific antigen...
BACKGROUND: Intravesical bacillus Calmette–Guérin (BCG) therapy is the standard adjuvant treatment for intermediate-high risk non–muscle-invasive bladder cancer (NMIBC). Transient elevations in prostate-specific antigen (PSA) following BCG instillation can prompt unnecessary prostate biopsies and increase patient anxiety. This study investigated temporal changes in total PSA levels (TPSA) and Free-to-Total PSA ratio (f/tPSA) in NMIBC patients receiving intravesical BCG therapy. METHODS: We prospectively enrolled 25 male patients with NMIBC and baseline TPSA < 4 ng/mL. Serum TPSA and free PSA were measured at three time points: prior to BCG initiation as baseline, immediately after the induction course, and three months post-treatment. Patients with prior prostate cancer, inflammatory prostate conditions, or use of medications affecting PSA were excluded. Data were analyzed using Friedman test to compare the three time points, followed by post-hoc pairwise comparisons using Wilcoxon signed-rank tests (SPSS v27). RESULTS: Twenty patients completed the study (mean age 64.0 ± 8.4 years), Sixteen patients (80%) exhibited a significant elevation of TPSA immediately following induction therapy. In 14 of these patients (> 80%), PSA levels spontaneously returned to near-baseline values within three months. Mean TPSA rose from 1.17 ± 1.24 ng/mL at baseline to 2.02 ± 1.48 ng/mL following intravesical BCG therapy course, the declined to 1.27 ± 1.24 ng/mL at three months post-treatment. The mean f/tPSA exhibited a steadier trend, declining from 0.30 ± 0.16 at baseline to 0.26 ± 0.12 ng/mL post-treatment, and a slight increasing to 0.28 ± 0.16 ng/mL at three months. Statistical analysis confirmed that the post-treatment elevations in TPSA and was significant (p < 0.001). No patient developed clinical or histopathological evidence of prostate cancer during follow-up. CONCLUSION: Transient PSA elevation is a common but reversible phenomenon after intravesical BCG instillation, reflecting local inflammatory and immune responses rather than malignant transformation. In the absence of additional clinical findings, a strategy of “watchful waiting” with repeat PSA testing at three months may prevent unnecessary prostate biopsies, reduce patient anxiety, and optimize healthcare resource utilization.
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