BMC Urology[JOURNAL]
Sun
200 papers
A case report of pathological complete response in an elderly patient with advanced urothelial carcinoma treated with disitamab vedotin plus toripalimab.
Songlin L, Yunxun L, Peiyu H … +2 more , Wen H, Mingyong L
BMC Urol · 2026 Jun · PMID 42310572 · Full text
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.
Genetically predicted urinary sodium excretion and urolithiasis risk: a two-sample mendelian randomization study.
Huang D, Li H, Yang S
BMC Urol · 2026 Jun · PMID 42298530 · Full text
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.
Association between fibrinogen-albumin ratio and erectile dysfunction: a retrospective cross-sectional study.
Yuce A, Benli E, Arslan A … +3 more , Acet AA, Ayaz A, Cirakoglu A
BMC Urol · 2026 Jun · PMID 42288818 · Full text
OBJECTIVE: The fibrinogen-to-albumin ratio (FAR) is a new marker used in inflammatory processes and is effective in demonstrating associated microvascular damage. The aim of this study was to evaluate the relationship be...
OBJECTIVE: The fibrinogen-to-albumin ratio (FAR) is a new marker used in inflammatory processes and is effective in demonstrating associated microvascular damage. The aim of this study was to evaluate the relationship between FAR and erectile dysfunction (ED), a sexual intercourse disorder associated with inflammatory processes and endothelial dysfunction. METHODS: Data from 1876 patients presenting with ED between January 2020 and 2025 were evaluated. A total of 424 patients, 214 in the ED group and 210 in the control group, were included in the study. Anthropometric measurements and biochemical examinations of the patients were recorded. FAR values were compared between the ED group, ED subgroups, and the control group. The cut-off value for the FAR value and the potential correlation between ED severity were examined. RESULTS: The FAR value was calculated as 89.4 ± 27.3 in the ED group and 67.8 ± 18.8 in the control group (p < 0.001). The optimal cut-off value for FAR was found to be 101.49 with 33% sensitivity and 99% specificity. FAR values were significantly higher in the ED subgroups compared to the control group. A moderate linear correlation was found between IIEF-5 scores and FAR values (r = -0.554, p < 0.001). The FAR value (AUC = 0.724) was found to be more successful in distinguishing between diseased and healthy individuals than CAR (AUC = 0.647), a similar inflammatory marker. CONCLUSION: It has been shown that FAR is significantly associated with the presence and severity of ED and can be a reliable and easily accessible marker to support the diagnosis of ED.
Depression, anxiety, and health related quality of life following radical prostatectomy and radiation treatment: 12 month outcomes in a South African cohort.
Irusen H, Fernandez P, Esterhuizen T … +3 more , van der Merwe A, Spies P, Seedat S
BMC Urol · 2026 Jun · PMID 42286556 · Full text
PURPOSE: Longitudinal patient-reported outcomes comparing radical prostectomy (RP) and radiation (RT) for localized prostate cancer (CaP) in low- to middle- income countries are limited. We examined the comparative cours...
PURPOSE: Longitudinal patient-reported outcomes comparing radical prostectomy (RP) and radiation (RT) for localized prostate cancer (CaP) in low- to middle- income countries are limited. We examined the comparative course of depression and anxiety and their association with health related quality of life (HRQOL) in men treated with RP or RT over a year post-treatment. METHODS: Data from 161 South African (SA) men with CaP were analysed. Depression, Anxiety, HRQOL, and relevant covariates were measured at baseline, 3, 6, 9, and 12 months. We used the following validated scales: Centre for Epidemiologic Studies Depression (CES-D), State Trait Anxiety Inventory (STAI-S), European Organisation for Research and Treatment in Cancer Quality of Life (EORTC QLQ-PR25), Multidimensional Scale of Perceived Social Support (MSPSS), Memorial Anxiety Scale for Prostate Cancer (MAX-PC), Connor-Davidson Resilience Scale (CD-RISC), and Decisional Conflict Scale (DCS). RESULTS: Depressive symptoms (CES-D ≥ 16) remained elevated 12 months post-RP (baseline: 43%; 3-month: 37%; 6-month: 47%; 12-month: 42%), while RT prevalence declined (39% to 29%). Similarly, anxiety (STAI-S ≥ 39) was more prevalent and persistent in the RP group (29% to 23%; 6-month peak: 28%) compared to the RT group (26% to 15%), where scores consistently declined throughout the first year. Overall urinary morbidity was marked in the first six months (β = 11.828; 95% CI: 7.931to 15.73; p < 0.001). More men in the RP group exhibited higher incontinence aids use (β = -21.477; 95% CI: to 33.261 to 9.694; p < 0.001). Sexual function in RP was lower (β = 18.006; 95% CI: 6.881 to 29.131; p = 0.002) with increased sexual activity from month nine onwards (β = -13.203; 95% CI: -23.489 to -2.916; p = 0.012). RT was associated with bowel symptoms in the latter half of follow-up. (4.681; 95% CI: 0.702 to 8.659; p = 0.021). Depression and anxiety adversely affected all HRQOL functional and symptom domains except sexual activity. CONCLUSION: The high prevalence of depression and anxiety reflects marked psychological morbidity in men treated for CaP in the first year post-treatment. Given the substantial association between psychological impairment and HRQOL, integrating mental health screening, management and referral into uro-oncology protocols is critical.
Effect of music intervention on anxiety and pain after anatomical endoscopic enucleation of the prostate: a prospective randomized controlled trial.
Barlas IS, Yilmaz M, Aybal HC … +3 more , Duvarci M, Guven S, Tunc L
BMC Urol · 2026 Jun · PMID 42271365 · Full text
BACKGROUND: This prospective randomized study aimed to assess the effect of self-selected music, delivered via loudspeaker, on early postoperative anxiety and pain in patients who underwent anatomical endoscopic enucleat...
BACKGROUND: This prospective randomized study aimed to assess the effect of self-selected music, delivered via loudspeaker, on early postoperative anxiety and pain in patients who underwent anatomical endoscopic enucleation of the prostate (AEEP) under spinal anesthesia without sedation. METHODS: Adult male patients scheduled for AEEP were randomly allocated to either a music intervention group (self-preferred music) or a control group (no music). Baseline characteristics, preoperative urethral catheter status, International Prostate Symptom Scores (IPSS), operative duration, and pre- and postoperative anxiety scores (State Anxiety Inventory, SAI) were recorded. Visual Analog Scale (VAS) was used to evaluate postoperative pain two hours after surgery. RESULTS: A total of 135 patients were analyzed (music group, n= 67; control group, n= 68). Baseline characteristics and operative times were comparable between groups (p>0.05). The music group had significantly lower postoperative SAI (32.0 ± 7.32 vs. 38.38 ± 11.28; p = 0.001) and VAS scores (1 [1-2] vs. 2 [1-3]; p = 0.001). The reduction in postoperative SAI compared to preoperative value was also greater in the music group (14 [10.00-21.00] vs. 7 [1.00-11.75]; p = 0.001). Music type had no significant impact on outcomes (p>0.05). In multivariate analysis, music intervention and preoperative catheterization were independent predictors of postoperative anxiety. CONCLUSIONS: Self-selected music intervention significantly reduced early postoperative anxiety and pain following AEEP under spinal anesthesia. Given its simplicity and non-invasive nature, music may serve as an effective adjunct for enhancing patient comfort, regardless of music genre. CLINICAL TRIAL NUMBER: NCT07255118.
Bleeding-related outcomes after transurethral resection of prostate in patients with chronic antiplatelet or anticoagulant therapy following perioperative interruption: a retrospective cohort study.
Ilktac A, Dogan B, Ersoz C … +4 more , Kalkan S, Akıncı S, Akcay M, Ilbey YO
BMC Urol · 2026 Jun · PMID 42265650 · Full text
BACKGROUND: Transurethral resection of the prostate (TURP) is s the gold standard surgical treatment method for benign prostatic hyperplasia. With the aging population and the increasing prevalence of cardiovascular dise...
BACKGROUND: Transurethral resection of the prostate (TURP) is s the gold standard surgical treatment method for benign prostatic hyperplasia. With the aging population and the increasing prevalence of cardiovascular diseases, the number of patients requiring anticoagulant (AC) or antiplatelet (AP) therapy continues to rise. The perioperative management of these medications remains challenging because continuation may increase bleeding complications, whereas discontinuation may increase thromboembolic risk. In this study, we evaluated bleeding-related outcomes after TURP in patients receiving chronic AP or AC therapy undergoing perioperative medication interruption. METHODS: This retrospective study included patients who underwent TURP between January 2020 and December 2024 at our tertiary referral center. Patients were divided into three groups according to their perioperative use of AP and AC medications. CONTROL GROUP: Patients who did not receive any AC or AP therapy. AP group: Patients receiving antiplatelet therapy. AC group: Patients treated with anticoagulants. None of the patients underwent TURP under continued AP or AC therapy. Perioperative and postoperative outcomes, including duration of irrigation, duration of catheterization, length of hospital stay, development of clot retention during hospitalization, need for postoperative blood transfusion, readmission due to hematuria within 30 days, and need for recatheterization or reoperation due to bleeding, were evaluated. A composite bleeding outcome was created to increase statistical power including postoperative blood transfusion, clot retention, and hematuria-related readmission. RESULTS: A total of 325 patients were included: 198 in the control group, 97 in the AP group, and 30 in the AC group. Overall comparisons showed significant differences in postoperative transfusion (p = 0.001) and hematuria-related readmission rates (p = 0.032) between three groups but post-hoc pairwise Fisher's exact tests with Bonferroni correction did not confirm statistical significance between specific pairs. There were no significant differences between the groups in other parameters. Multivariable logistic regression identified antiplatelet therapy as an independent predictor of hematuria-related readmission (OR:4.17, p = 0.010). CONCLUSION: AP therapy is independently associated with an increased risk of hematuria-related readmission even after perioperative interruption of therapy. Patients receiving antithrombotic therapy should be carefully monitored during the perioperative period, and clinicians should remain vigilant for potential bleeding-related complications.
Emergency management of ureteral stones with SWL: is there any advantage over elective approach?
Guzel R, Kanberoglu AF, Yildirim S … +2 more , Simsek G, Sarica K
BMC Urol · 2026 Jun · PMID 42260532 · Full text
INTRODUCTION: The optimal timing of extracorporeal shock wave lithotripsy (ESWL) for ureteral stones remains unclear. This study aimed to compare the clinical and radiological outcomes of emergency versus elective ESWL i...
INTRODUCTION: The optimal timing of extracorporeal shock wave lithotripsy (ESWL) for ureteral stones remains unclear. This study aimed to compare the clinical and radiological outcomes of emergency versus elective ESWL in patients presenting with ureteral calculi. METHODS: In this retrospective study, 66 patients who underwent ESWL at our institution between June 2023 and December 2024 were included. Patients were categorized into emergency (n = 32) and elective (n = 34) ESWL groups. All procedures were performed using a Modulith SLK Inline lithotripter (Storz Medical, Switzerland) with up to 3,000 shocks per session at 60-90 shocks per minute under NSAID analgesia. Demographic characteristics, stone-related parameters (size, volume, density), procedural variables (session number, duration), stone-free (SF) rates, post-procedural emergency visits, and infectious complications were analyzed. Stone-free status was assessed 7 days after the final ESWL session. RESULTS: There were no significant differences between the emergency and elective groups regarding age, sex, body mass index (BMI), or comorbidities. Stones in the emergency ESWL group were significantly larger (8.2 ± 2.65 mm vs. 7.7 ± 1.74 mm; p = 0.023) while stone volume was similar. The number of ESWL sessions and total procedure duration did not differ significantly. Stone-free rates were comparable between groups (65.6% vs. 67.6%; p = 0.862). Post-treatment emergency department visits (31.3% vs. 20.6%; p = 0.322) and infectious complications (15.6% vs. 5.9%; p = 0.199) did not differ significantly. CONCLUSION: Emergency ESWL was associated with stone-free rates comparable to elective ESWL in carefully selected patients, despite a larger mean stone size in the emergency ESWL group. However, the numerically higher infectious complication rate in the emergency group warrants cautious interpretation. These findings suggest that emergency ESWL may represent a feasible early treatment option for selected patients with symptomatic ureteral stones.
Immunotherapy in bladder cancer: a systematic review of clinical trials and therapeutic advances.
Alasker A, Alghafees M, Nammor T … +6 more , Alanazi N, Alferayan T, Almanie A, Alrashed M, Almarzouq Y, Alammari A
BMC Urol · 2026 Jun · PMID 42260513 · Full text
BACKGROUND: Bladder cancer poses significant morbidity, mortality, and healthcare burdens globally. While non-muscle-invasive bladder cancer often initially responds to intravesical Bacillus Calmette-Guérin, many patient...
BACKGROUND: Bladder cancer poses significant morbidity, mortality, and healthcare burdens globally. While non-muscle-invasive bladder cancer often initially responds to intravesical Bacillus Calmette-Guérin, many patients become unresponsive to Bacillus Calmette-Guérin, resulting in recurrence or progression. Emerging immunotherapies, including checkpoint inhibitors (Pembrolizumab, Atezolizumab, Durvalumab), intravesical gene therapies (Nadofaragene Firadenovec, Cretostimogene Grenadenorepvec), and novel cytokine-based therapies, present promising alternatives. This systematic review thoroughly synthesizes existing clinical evidence from phase 2 and 3 trials, critically assessing immunotherapeutic options for bladder cancer treatment. METHODS: A comprehensive search was systematically conducted across four databases: PubMed, Cochrane, Web of Science and Scopus strictly adhering to PRISMA guidelines and retrospectively registered. Included studies evaluated immunotherapies in non-muscle-invasive bladder cancer and selected muscle-invasive bladder cancer populations. Two reviewers independently performed study screening, data extraction, and risk-of-bias assessments using the Cochrane Risk-of-Bias tool. Results were synthesized both qualitatively, incorporating detailed comparative analyses and robust statistical descriptions. RESULTS: A total of 778 studies were initially identified. Intravesical Cretostimogene Grenadenorepvec demonstrated the highest complete response [1] rate (75.2%), with impressive durability (83% maintaining response ≥ 12 months). Intravesical Nadofaragene Firadenovec also exhibited notable efficacy (CR 53.4%, median duration 9.69 months). Nogapendekin Alfa Inbakicept combined with Bacillus Calmette-Guerin achieved a robust CR (71%) and a remarkably sustained response (median 26.6 months). Systemic Pembrolizumab showed moderate efficacy (43.5% 12-month disease-free survival) but raised significant toxicity concerns (14% grade ≥ 3 adverse events). Intravesical therapies consistently provided superior cystectomy avoidance (≥ 89% at 12 months) compared to systemic treatments. Safety profiles significantly favored intravesical therapies, which had predominantly mild (grade 1-2) adverse events, while systemic therapies reported notable severe toxicities and treatment-related fatalities. CONCLUSIONS: Intravesical immunotherapies, particularly Nogapendekin Alfa Inbakicept and Bacillus Calmette-Guerin and Nadofaragene, demonstrate superior efficacy, significant response durability, and favorable safety profiles in treating bladder cancer compared to systemic checkpoint inhibitors, which display moderate efficacy and notable safety concerns. These findings strongly support prioritizing intravesical therapies in non-muscle-invasive bladder cancer management, especially for patients who are unresponsive to Bacillus Calmette-Guerin. Future research should focus on head-to-head randomized controlled trials and biomarker-driven patient selection to optimize clinical outcomes.
AirSeal versus conventional insufflation in robot-assisted radical prostatectomy: effects on operative efficiency, pain, and perioperative outcomes.
Aykanat IC, Muduroglu M, Mese SK … +7 more , Ozkan A, Gurbuz A, Koseoglu E, Kordan Y, Balbay MD, Esen T, Canda AE
BMC Urol · 2026 Jun · PMID 42260479 · Full text
BACKGROUND: Robot-assisted radical prostatectomy (RARP) requires a stable pneumoperitoneum to maintain optimal surgical conditions. The AirSeal Intelligent Flow System has been developed to provide continuous pressure re...
BACKGROUND: Robot-assisted radical prostatectomy (RARP) requires a stable pneumoperitoneum to maintain optimal surgical conditions. The AirSeal Intelligent Flow System has been developed to provide continuous pressure regulation and smoke evacuation; however, its clinical impact during RARP remains incompletely defined. OBJECTIVE: To compare perioperative, oncological, and postoperative recovery outcomes between the AirSeal system and conventional insufflation systems during RARP. METHODS: We retrospectively analyzed patients who underwent RARP at a high-volume tertiary center in a retrospective before-and-after cohort design. Patients were stratified according to the insufflation system used during surgery: conventional insufflation system (CIS) or the AirSeal system. Demographic characteristics, perioperative parameters, pathological outcomes, postoperative complications (Clavien-Dindo), postoperative pain scores and opioid consumption were evaluated. RESULTS: A total of 749 patients were included (CIS: 398; AirSeal: 351). Baseline demographic and clinical characteristics were comparable between the groups. Operative time was significantly shorter in the AirSeal group (183 ± 77.7 vs. 217.4 ± 73.0 min; p < 0.001). Estimated blood loss, transfusion rates, and length of hospital stay were similar between the groups. Pathological stage distribution differed between the groups, with a higher proportion of locally advanced disease (≥pT3) in the AirSeal cohort (49.3% vs 39.2%; p = 0.005). However, other oncological outcomes, including pathological ISUP grade distribution, lymph node involvement, and positive surgical margin rates, were comparable. Overall postoperative complication rates were similar between the groups; however, high-grade complications (Clavien-Dindo ≥III) occurred less frequently in the AirSeal group. Postoperative pain scores at 1, 6, and 24 hours were significantly lower in the AirSeal group (all p < 0.001), postoperative morphine consumption at 24 hours was also significantly reduced (p < 0.001). CONCLUSIONS: Use of the AirSeal insufflation system during RARP was associated with shorter operative times, lower postoperative pain scores, and less frequent high-grade complications. Positive surgical margin rates and lymph node involvement were comparable between the groups. However, given the retrospective before-and-after design, differences in surgical periods and pneumoperitoneum pressure between the groups, these findings should be considered observational and hypothesis-generating.
Feasibility and preliminary safety of urologic telesurgery using Chinese surgical systems: a single-center exploratory case series.
Xu T, Wang Z, Qi A … +4 more , Guo M, Wang J, Guo P, Wang Z
BMC Urol · 2026 Jun · PMID 42260478 · Full text
PURPOSE: Telesurgery offers a solution to the uneven distribution of surgical resources by enabling telesurgery through surgical robotic systems. This study aimed to describe the technical feasibility and preliminary sho...
PURPOSE: Telesurgery offers a solution to the uneven distribution of surgical resources by enabling telesurgery through surgical robotic systems. This study aimed to describe the technical feasibility and preliminary short-term safety of urologic telesurgery using Chinese surgical systems (CSS). METHODS: This single-center exploratory descriptive case series evaluated urologic telesurgery using CSS between January 2023 and October 2025. A total of 6 consecutive eligible telesurgeries were included: 3 robot-assisted radical prostatectomies (RARP) and 1 robot-assisted partial nephrectomy (RAPN) were performed with the Edge MP1000 (MP1000) system, and 1 RAPN and 1 robot-assisted radical cystectomy (RARC) were performed with the KangDuo SR-2000 (KD-SR-2000) system. Six locally performed RARP cases using the da Vinci Xi (DV-Xi) system during the same study period were retrospectively collected as a limited contextual reference for the RARP subgroup. The primary outcome was technical success, defined as completion without conversion. Secondary descriptive outcomes included perioperative safety events, 30-day Clavien-Dindo complications (CDC), network performance, and, in the RARP subgroup, positive surgical margin (PSM) rate, estimated blood loss (EBL), operative time, suture-per-stitch time, and 4-week urinary continence recovery after catheter removal. RESULTS: All six telesurgeries were completed without intraoperative conversion or major complications. In the RARP subgroup, remote MP1000 procedures were summarized alongside locally performed DV-Xi procedures as a limited contextual reference. PSM rate and early urinary continence recovery showed no obvious unfavorable signal in this small contextual cohort, whereas operative time and suture-per-stitch time were longer, and EBL was numerically higher, in remote procedures. Mean Network round-trip latency for telesurgery ranged from 6.13 ± 0.71 ms (Harbin-Harbin, 2 km) to 54.12 ± 0.58 ms (Harbin-Hangzhou, 2200 km), with no frame loss. CONCLUSION: In this small selected case series, urologic telesurgery using CSS was technically feasible and preliminary safety under stable telecommunication conditions.
Preoperative superselective transarterial ICG-lipiodol embolization for endophytic renal tumors in robot-assisted partial nephrectomy: a preliminary feasibility report.
Hsieh CC, Chiang TY, Tseng WH … +4 more , Liu CL, Wu RH, Huang SK, Chiu AW
BMC Urol · 2026 Jun · PMID 42260455 · Full text
Partial nephrectomy for small, anatomically complex renal tumors presents significant navigational challenges. This study aims to evaluate the synergistic hemostatic and navigational utility and surgical outcomes of preo...
Partial nephrectomy for small, anatomically complex renal tumors presents significant navigational challenges. This study aims to evaluate the synergistic hemostatic and navigational utility and surgical outcomes of preoperative superselective indocyanine green (ICG) embolization during retroperitoneal robot-assisted partial nephrectomy (RAPN). We retrospectively reviewed 32 patients who underwent retroperitoneal RAPN for small renal masses (< 4 cm). Patients were stratified by preoperative intervention: 9 patients (28.1%) received superselective transarterial delivery of an ICG-lipiodol mixture with coil embolization 3 h prior to surgery, while 23 patients (71.9%) underwent standard RAPN. A uniform main renal artery clamping protocol was maintained across both cohorts to evaluating the combined utility of ICG. Strikingly, the ICG cohort consisted entirely of completely endophytic tumors (E3 component: 100% vs. 13%, p < 0.001). Despite this extreme anatomical complexity, the ICG group demonstrated significantly shorter median operative time (90.0 vs. 100.2 min, p = 0.049) and lower median estimated blood loss (100 vs. 350 mL, p = 0.039). Consequently, the perioperative blood transfusion rate was lower in the ICG group (11.1% vs. 60.9%, p = 0.018). Median warm ischemia time (16.48 vs. 16.78 min, p = 0.900) and postoperative renal function changes at day 1, 6 months, and 1 year were comparable between groups. No gastrointestinal or embolization-related complications were observed. Our preliminary experience demonstrates that preoperative superselective ICG embolization serves as a feasible and safe adjunct during RAPN for completely endophytic tumors. By providing a synergistic combination of direct local hemostasis and real-time fluorescent navigation, this tailored approach facilitates precise tumor localization. While these initial findings suggest potential perioperative advantages, they should be interpreted as exploratory signals awaiting further validation in larger, well-balanced cohorts.
Association between CYP2C19 gene polymorphisms and analgesic response to meperidine in emergency department patients with renal colic: a prospective observational study.
Baykara Sayili S, Koseler A, Erdur B
BMC Urol · 2026 Jun · PMID 42252451 · Full text
BACKGROUND: Renal colic is a urologic emergency that presents with characteristic severe pain and is mostly seen in emergency services. The preferred medications are NSAIDs, paracetamol and opioids, but considering the s...
BACKGROUND: Renal colic is a urologic emergency that presents with characteristic severe pain and is mostly seen in emergency services. The preferred medications are NSAIDs, paracetamol and opioids, but considering the severity of pain, opioid analgesics should be advised. The aim of this study is to determine the relationship between meperidine efficacy and CYP2C19 gene polymorphisms. METHODS: This prospective observational study was conducted between 01.07.2017 and 01.10.2018 in the Pamukkale University Faculty of Medicine Emergency Department. Our study subjects included 203 patients with renal colic and 102 individuals presenting with abdominal pain but not diagnosed with renal colic were included only for genetic frequency analysis; this group was not included in the intervention safety/efficacy analyses. 203 patients were given 100 mg of meperidine and observed 60 min later, and vital signs, laboratory values, etc., were recorded. RESULTS: The age and sex distributions were similar between the case and control groups. There was no statistically significant difference between the sexes in visual analog scale (VAS) scores at any time (0.min-15.min-30.min-60.min). The normal-activity/rapid metabolizer groups had significantly lower 30- and 60-min VAS scores than did the moderate-activity groups. The percentages of VAS decreases at 30 and 60 min from baseline were significantly greater in the normal-activity rapid metabolizer group than in the moderate-activity group. This study revealed that the efficacy of the drug was not affected by age, sex or stone location. The VAS score decreased significantly at all time intervals. Additionally, the decrease in the VAS score between 0 and 15 min after drug administration was similar in each genotype group, but after 30 min, it was remarkable for the CYP2C19 1/1 genotype. During follow-up, 11 patients had drug-related adverse events (most commonly nausea and dizziness). No serious events occurred, and no additional interventions or hospitalizations were required. CONCLUSIONS: This study suggested that the effectiveness of meperidine in treating renal colic may be influenced by the genetic polymorphism of CYP2C19 in the patient. The pain response was markedly reduced in individuals with the CYP2C19 *1/*1 genotype. The age, sex, and stone localization groups were seemingly comparable with respect to the efficacy of meperidine. It is advisable to consider the genetic profile in individualized treatment approaches, with the aim of increasing drug efficacy and optimizing dose adjustments.
Diagnostic value of PSA-based markers in prostate cancer: a retrospective analysis stratified by body mass index.
Yang T, Zhang Q, Liu Z … +3 more , Tian J, Hu X, Lv Z
BMC Urol · 2026 Jun · PMID 42251295 · Full text
OBJECTIVE: Body mass index (BMI) influences the accuracy of prostate-specific antigen (PSA) in prostate cancer (PCa) diagnostic performance. This study investigates the effect of BMI on conventional PSA-based markers and...
OBJECTIVE: Body mass index (BMI) influences the accuracy of prostate-specific antigen (PSA) in prostate cancer (PCa) diagnostic performance. This study investigates the effect of BMI on conventional PSA-based markers and evaluates a novel age-adjusted PSA density parameter (A-PSAD) to optimize diagnostic performance strategies across different BMI groups. RESULTS: The cohort comprised 307 low-BMI (91 PCa, 216 benign) and 356 high-BMI (109 PCa, 247 benign) patients. In the low-BMI group, A-PSAD yielded the highest diagnostic efficacy (AUC = 0.714), outperforming PSAD (0.685) and total PSA (TPSA, 0.588). In the high-BMI group, A-PSAD also demonstrated superior performance (AUC = 0.793) compared to PSAD (0.774) and TPSA (0.613). A-PSAD's overall diagnostic value was significantly higher than conventional markers across both groups (P < 0.01). Furthermore, LASSO regression identified four optimal predictive variables for the low-BMI group and seven for the high-BMI group; A-PSAD consistently emerged as a core independent predictor in both. CONCLUSION: BMI significantly modulates the diagnostic efficacy of PCa diagnostic performance indicators. A-PSAD demonstrates robust, superior diagnostic value across varying BMI categories, serving as a promising primary diagnostic performance tool to optimize individualized pre-biopsy risk stratification.
Perioperative complications of laparoscopic sacrohysteropexy versus sacrocolpopexy with subtotal hysterectomy for pelvic organ prolapse.
Alanazi S, Alshammari N, Jrais A … +4 more , Alharbi N, Alsaadoon M, Alanazi Y, Alsahabi J
BMC Urol · 2026 Jun · PMID 42249363 · Full text
BACKGROUND: Pelvic organ prolapse (POP) affects 23.4% of women in Saudi Arabia. Laparoscopic sacrocolpopexy is the established surgical gold standard; however, whether concomitant hysterectomy confers additional perioper...
BACKGROUND: Pelvic organ prolapse (POP) affects 23.4% of women in Saudi Arabia. Laparoscopic sacrocolpopexy is the established surgical gold standard; however, whether concomitant hysterectomy confers additional perioperative risk remains debated. METHODS: This retrospective cohort study included 179 women who underwent laparoscopic sacrocolpopexy with subtotal hysterectomy (n = 119) or laparoscopic sacrohysteropexy (n = 60) at two tertiary referral centers in Riyadh, Saudi Arabia, between 2009 and 2024. Intraoperative and postoperative complications, perioperative hemoglobin change, and hospital stay duration were compared between groups. RESULTS: The sacrocolpopexy group was significantly older (P = 0.004). Organ injury occurred in 0.6% of cases overall. Blood transfusion was required exclusively in the sacrohysteropexy group (3.3% vs. 0.0%, P = 0.045). Both groups demonstrated a statistically significant postoperative hemoglobin decline - sacrocolpopexy: 124.52 ± 15.07 to 110.60 ± 13.77 g/L; sacrohysteropexy: 125.27 ± 13.20 to 110.29 ± 12.18 g/L (P < 0.001) - with no significant between-group difference (P = 0.747) and neither decline reaching clinical significance. Sacrohysteropexy was associated with shorter hospitalization (44.6% vs. 24.6% discharged within two postoperative days, P = 0.012). Reoperation rates and symptom resolution were comparable between groups. CONCLUSIONS: No significant between-group differences in perioperative morbidity were detected. Sacrohysteropexy was associated with shorter hospital stay; however, the clinical relevance of the higher transfusion rate is uncertain, given the small event count. Given baseline group non-comparability and the retrospective design, these results should be regarded as exploratory. The surgical approach should be individualized based on patient characteristics and the surgeon's expertise. Prospective randomized trials are warranted.
Digital tracking of ureteral stents with the stentless application: clinical outcomes in 200 patients.
Giurgiu L, Buzoianu MM, Medan PA … +9 more , Andras I, Dobrotă F, Peia R, Vranău SP, Medan Ș, Rus B, Ognean R, Coman I, Crișan N
BMC Urol · 2026 Jun · PMID 42243855 · Full text
BACKGROUND AND OBJECTIVES: Ureteral double-J stents (UDJS) are frequently placed in urologic practice for a range of indications, including ureteral obstruction, strictures, stone disease, peri- and post-ureteroscopy, an...
BACKGROUND AND OBJECTIVES: Ureteral double-J stents (UDJS) are frequently placed in urologic practice for a range of indications, including ureteral obstruction, strictures, stone disease, peri- and post-ureteroscopy, and following ureteral reconstruction or reimplantation. Recent studies suggest that approximately 13% of inserted stents become overdue or neglected, which can lead to serious, potentially life-threatening complications. We therefore aimed to develop a smartphone application to track patients with UDJS and reduce the incidence of overdue indwelling ureteral stents. MATERIALS AND METHODS: For the development of the application, we worked with a specialized team of programmers. To facilitate universal access to the complete patient database, a cloud-based database was implemented. The application was designed to send a Short Message Service (SMS) to the patients and their general practitioner to remind the timing for UDJS extraction. We prospectively enrolled a total of 200 patients who underwent UDJS insertion for any indication by six urologists from June 2023, to March 2024. The patients were divided into two groups: the first group was monitored using the Stentless mobile application, while the second group was monitored using an electronic patient registry. The two groups were compared with respect to stent overdue times and complete loss-to-follow-up rates. RESULTS: In this study, a total of 200 patients were enrolled non-randomly and assigned to one of the study groups. 100 patients assigned to group 1 (mobile application group) and 100 to group 2 (electronic registry group). Among these, 187 patients (93.5%) underwent unilateral ureteral stent placement, while 13 patients (6.5%) required bilateral stent placements. The study also included patients with long-term indwelling stents, with the maximum stent replacement interval extending up to 360 days. The median indwelling time across the cohort was 17 days (range 14-360), reflecting the inclusion of long-term stents. In group 1, no patients missed their scheduled stent removal appointments, corresponding to an LTFU rate of 0% and no overdue removals. In group 2, four patients failed to attend their scheduled appointments (p = 0.121). These patients were identified through the electronic patient registry and subsequently contacted for follow-up. The delay in stent removal among these four patients was (7, 10, 13, and 60 days) beyond the planned appointment date. Notably, one patient from group 2 presented with an encrusted stent requiring two flexible ureteroscopy procedures for removal. Ultimately, all ureteral stents were successfully removed in an office-based setting, ensuring complete management for all participants. CONCLUSIONS: By notifying the patient and general practitioner with a mobile phone text message automatically transmitted from the application, there is the potential to increase patient compliance, reduce the rate of those who have a UDJS and fail to return for follow-up, respectively to reduce the rate of patients presenting for complications due to stent encrusting.
Efficacy and safety of optical navigation system versus conventional fluoroscopy in sacral neuromodulation electrode implantation: a prospective randomized controlled trial.
Ziqin Z, Xin S, Yinjun G … +4 more , Tingting L, Weilin F, Jin H, Jianwei LV
BMC Urol · 2026 Jun · PMID 42243833 · Full text
BACKGROUND: Precise Stage I electrode implantation is critical for the success of sacral neuromodulation (SNM); however, conventional fluoroscopy-guided puncture is limited by reliance on bony landmarks and significant r...
BACKGROUND: Precise Stage I electrode implantation is critical for the success of sacral neuromodulation (SNM); however, conventional fluoroscopy-guided puncture is limited by reliance on bony landmarks and significant radiation exposure. This study evaluated the clinical value of an optical navigation system (ONS) combined with multimodal image fusion for SNM electrode implantation. METHODS: A prospective, single-blind, randomized controlled trial was conducted between March 2024 and June 2025. Eighty patients with refractory lower urinary tract dysfunction (including neurogenic bladder, overactive bladder, and interstitial cystitis/bladder pain syndrome) undergoing SNM were randomly assigned (1:1) to receive either ONS-assisted puncture (experimental group, n = 40) or conventional X-ray guidance (control group, n = 40). The primary outcome was the conversion rate to Stage II permanent implantation. Secondary outcomes included the number of puncture attempts, puncture time, total operative time, radiation dose, minimum effective voltage, and perioperative complications. RESULTS: Baseline characteristics were comparable between groups. The Stage II conversion rate was significantly higher in the ONS group than in the control group (87.5% vs. 62.5%, P < 0.05). Patients in the ONS group required fewer median puncture attempts [2.0 (2.0, 2.2) vs. 5.0 (4.0, 7.0), P < 0.01] and shorter puncture time [7.5 (5.8, 10.2) min vs. 16.0 (12.0, 25.0) min, P < 0.01]. Intraoperative radiation exposure was substantially reduced in the ONS group [145.5 (108.4, 202.3) mGy vs. 473.3 (354.5, 635.2) mGy, P < 0.01]. Furthermore, the minimum effective voltage was significantly lower in the ONS group [1.8 (1.8, 2.5) V vs. 2.8 (1.8, 3.0) V, P = 0.010], suggesting superior electrode-neural positioning accuracy. No surgical complications occurred in either group. CONCLUSIONS: ONS combined with multimodal image fusion significantly improves the precision of SNM electrode implantation, reduces surgical trauma and radiation exposure, and increases Stage II conversion rates. This technique demonstrates stable clinical efficacy across various etiologies of refractory lower urinary tract dysfunction and represents a valuable navigation tool warranting broader clinical adoption. TRIAL REGISTRATION: Chinese Clinical Trial Registry #ChiCTR2500098093 3/3/2025.
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.
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.
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.
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