BMC Urology[JOURNAL]
Sun
200 papers
Association between renal replacement therapy and in-hospital mortality in patients with severe acute kidney injury: a retrospective cohort study based on MIMIC-IV database.
Tian G, Lin Z, Chen Z … +8 more , Qiu Z, Zheng Z, Lin Y, Chen T, Xu Z, Cai Y, Wu K, Li X
BMC Urol · 2026 Jun · PMID 42226256 · Full text
BACKGROUND: Severe acute kidney injury (AKI) occurs frequently in intensive care unit (ICU) settings and correlates strongly with adverse patient outcomes. Whether renal replacement therapy (RRT) can effectively improve...
BACKGROUND: Severe acute kidney injury (AKI) occurs frequently in intensive care unit (ICU) settings and correlates strongly with adverse patient outcomes. Whether renal replacement therapy (RRT) can effectively improve mortality outcomes in these patients remains controversial, primarily due to interference from confounding by indication. Within nephrology and critical-care practice, identifying which severe-AKI subgroups derive a survival benefit from RRT is a question of direct bedside relevance, and observational analyses with rigorous bias control are particularly informative when balanced randomised data remain limited. METHODS: This retrospective cohort analysis utilized the MIMIC-IV database (version 2.2). The study population comprised adult patients (age ≥ 18 years) diagnosed with KDIGO Stage 3 AKI during their first ICU admission. Vascular causes of AKI (renal-artery stenosis, renal infarction, abdominal-aortic-aneurysm associated ischaemia) and clearly post-obstructive AKI were excluded a priori, as these phenotypes carry distinct trajectories that may not respond to RRT in a comparable manner. Patients were stratified into treatment and control groups based on RRT receipt. The clinical indication for RRT was operationalised through a composite set of pre-specified criteria (refractory hyperkalaemia, severe metabolic acidosis, refractory volume overload, uraemic complications, and oligo-anuria) that were entered into the propensity-score model in addition to severity scores and laboratory derangement, in order to reduce residual operator-dependent variation in the initiation decision. To address baseline characteristic differences, propensity score matching (PSM) was conducted using 1:1 nearest neighbor matching with a caliper of 0.02. The primary endpoint was in-hospital all-cause mortality; secondary endpoints encompassed ICU mortality, 28-day mortality, ICU length of stay, total hospital length of stay, RRT-related complications (catheter-associated bloodstream infection, mechanical line complications, bleeding events, and intradialytic hypotension), and renal recovery. Cox proportional hazards regression models were employed to calculate hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). Pre-specified subgroup analyses also stratified by chronic-kidney-disease status, RRT modality, and the qualifying KDIGO Stage-3 criterion (creatinine, urine output, or both). RESULTS: A total of 5,847 patients with KDIGO Stage 3 AKI were enrolled, of whom 2,156 (37%) underwent RRT. Pre-matching analysis revealed substantially greater disease severity in the RRT group (SOFA score: 12.4 ± 4.2 vs. 8.6 ± 3.8, P < 0.001). Following 1:1 PSM, 1,842 matched pairs were established, with all covariate standardized mean differences (SMDs) below 0.1, indicating satisfactory matching. Within the matched cohort, in-hospital mortality was lower in the RRT group than in the controls (35% vs. 42%, P = 0.002), and the corresponding mortality risk was reduced (HR = 0.78, 95%CI: 0.68-0.89, P < 0.001). The direction and magnitude of the association were consistent across CKD versus non-CKD strata, across the qualifying KDIGO Stage-3 criterion, and across RRT modality, and RRT-related complications were observed but did not exceed rates previously reported in the literature. Subgroup analyses confirmed consistent findings of RRT regardless of sepsis status, mechanical ventilation use, age, or disease severity. CONCLUSION: After the largest confounders for indication were controlled through propensity score matching, RRT was, at a minimum, non-inferior to non-RRT management with respect to in-hospital mortality, and the matched-cohort estimates were consistent with an association with reduced mortality, among patients with severe AKI. These findings should not be read as proof of a causal protective effect, but they support the position that, in appropriately selected critically ill patients with KDIGO Stage 3 AKI - particularly those with refractory hyperkalaemia, severe acidosis, oligo-anuria, or refractory volume overload - RRT should not be withheld on the basis of perceived futility.
Evolution of treatment and oncological outcomes in patients undergoing radical cystectomy: a comparative analysis across two decades at a tertiary center.
Suartz CV, Azevedo MFD, Brito PHS … +9 more , Setoue DND, de Moraes CMT, Sant'Anna PVH, da Silva LGP, Schumacher LB, Galvez VVS, Dener MC, Nahas WC, Ribeiro-Filho LA
BMC Urol · 2026 Jun · PMID 42226192 · Full text
BACKGROUND: Over the last two decades, significant advances in the perioperative management of muscle-invasive bladder cancer, such as enhanced recovery protocols, increased use of neoadjuvant chemotherapy, improved care...
BACKGROUND: Over the last two decades, significant advances in the perioperative management of muscle-invasive bladder cancer, such as enhanced recovery protocols, increased use of neoadjuvant chemotherapy, improved care pathways, and stronger multidisciplinary collaboration, have reshaped surgical outcomes. This study aimed to evaluate the evolution of care and oncological outcomes in patients undergoing radical cystectomy at a Brazilian tertiary cancer center over 20 years. METHODS: We retrospectively analyzed clinical, surgical, and pathological data from patients with bladder cancer who underwent radical cystectomy between January 2005 and April 2025. Patients were stratified into two cohorts according to the year of surgery (2005-2014 vs. 2015-2025). Survival analyses were performed using Kaplan-Meier curves to compare overall survival, cancer-specific survival, and recurrence-free survival between periods. RESULTS: A total of 733 patients were included (mean age, 66.2 years; 69.2% male). An age-adjusted Charlson Comorbidity Index ≥ 3 was present in 90.4%, and preoperative hydronephrosis in 41.5%. Locally advanced disease (pT3-pT4) occurred in 50.9%, lymph node positivity (pN+) in 26.6%, and 34.5% received neoadjuvant chemotherapy. Early complications (< 30 days) occurred in 51.2%, early reoperation in 19.3%, and late complications (30-90 days) in 24.0%, with 33.3% classified as Clavien-Dindo grade ≥ III. On multivariable Cox regression, treatment period remained independently associated with improved overall survival (HR 0.75, 95% CI 0.58-0.97; p = 0.029). Clinical stage was also independently associated with overall survival (overall p = 0.046), with advanced stage increasing the hazard of death (HR 1.48, 95% CI 1.08-2.02; p = 0.015). Kaplan-Meier analysis showed significantly improved overall, cancer-specific, and recurrence-free survival in 2015-2025 versus 2005-2014 (all log-rank p < 0.001). CONCLUSION: Improved survival after radical cystectomy over the last decade reflects advances in perioperative care in the management of bladder cancer patients undergoing radical cystectomy.
Spinal venous hypertension secondary to nutcracker syndrome-a previously unreported cause of congestive myelopathy.
Chang F, Li S, Zhou Y … +5 more , Li K, Tang S, Ma Z, Zhang J, Chen F
BMC Urol · 2026 Jun · PMID 42226056 · Full text
OBJECTIVE: We report a case of myelopathy associated with nutcracker syndrome. Clinical and imaging findings indicate that nutcracker syndrome caused left renal vein stenosis, resulting in spinal venous hypertension. CAS...
OBJECTIVE: We report a case of myelopathy associated with nutcracker syndrome. Clinical and imaging findings indicate that nutcracker syndrome caused left renal vein stenosis, resulting in spinal venous hypertension. CASE PRESENTATION: A 15-year-old girl presented with abnormal sensations in both lower limbs, followed by progressive motor impairment and bowel and bladder dysfunction. Magnetic resonance imaging (MRI) revealed an abnormal signal in the spinal cord at the T12-L1 level. Although she was initially diagnosed with acute transverse myelitis (ATM) and treated with intravenous steroids, cerebrospinal fluid (CSF) analysis showed no signs of inflammation. Further evaluation with Doppler ultrasound and left renal arteriovenous angiography suggested that nutcracker syndrome led to compression of the left renal vein, with aberrant venous branches draining into the spinal venous system. This resulted in spinal venous hypertension and subsequent spinal cord injury. Initial treatment with corticosteroids and immunoglobulins was discontinued due to disease progression. After identifying a left renal vein vascular malformation at an external hospital, balloon dilation of the left renal vein was performed, yielding mild symptomatic relief. Subsequent interventional embolization of the malformed vessels temporarily improved symptoms, though her condition later deteriorated. Ultimately, she underwent laparoscopic robot-assisted external stent placement in the left renal vein at our institution. During the three-month postoperative follow-up, sensory function gradually improved and the clinical condition stabilized. CONCLUSIONS: To our knowledge, this is the first reported case of spinal venous hypertension syndrome secondary to nutcracker syndrome, presenting as myelopathy. We emphasize that in cases of acute myelitis or spinal cord disease of unknown etiology, screening for extramedullary vascular abnormalities-such as left renal artery or vein compression or malformations-should be considered, particularly when inflammatory markers are absent or treatment response is atypical.
Prospective comparative validation of a novel endoscopy chair and endoscope manipulation apparatus (EasyFlex) for ergonomic improvement in fURS procedures.
Toksoz S, Asik A, Kizilkan Y … +4 more , Senel S, Koseoglu B, Erdogan E, Sarica K
BMC Urol · 2026 May · PMID 42216216 · Full text
BACKGROUND: This study aimed to validate the functionality and usability of a doctor's endoscopy chair and an endoscope carrying/manipulation apparatus known as the EasyFlex. METHODS: Prototype models of the EasyFlex app...
BACKGROUND: This study aimed to validate the functionality and usability of a doctor's endoscopy chair and an endoscope carrying/manipulation apparatus known as the EasyFlex. METHODS: Prototype models of the EasyFlex apparatus were evaluated by five expert urologists specializing in endourology at three medical centers. The surgical and ergonomic advantages of the doctor's endoscopy chair and the endoscope carrying/manipulation apparatus were compared with those used during traditional flexible ureterorenoscopy (fURS) procedures for kidney stones, with ergonomic outcomes assessed using the Ergomini scale. RESULTS: The ergonomic evaluation of both systems revealed that surgeons experienced significantly greater ergonomic discomfort during traditional fURS procedures compared to those using the EasyFlex system, as indicated by higher total ergonomic scores (37.6 vs. 12.6, p < 0.001). Furthermore, the EasyFlex group demonstrated a significantly lower rate of intraoperative complications than the traditional fURS group (11.8% vs. 27%, p = 0.017). CONCLUSION: Compared with the traditional approach, the results obtained in our study demonstrated that the EasyFlex apparatus could provide superior ergonomic conditions during fURS procedures. Additionally, the rate of intraoperative complications was lower in the EasyFlex group.
The impact of preoperative CT-based 3D visualization model on ureteric access sheath placement failure without pre-stenting.
Zhang Y, Hu C, Li H
BMC Urol · 2026 May · PMID 42216161 · Full text
BACKGROUND: Placement failure of the flexible and navigable suction ureteral access sheath (FANS) with negative pressure suction may occur during retrograde intrarenal surgery (RIRS) due to ureteral stricture, hemorrhage...
BACKGROUND: Placement failure of the flexible and navigable suction ureteral access sheath (FANS) with negative pressure suction may occur during retrograde intrarenal surgery (RIRS) due to ureteral stricture, hemorrhage, injury and other factors. This study aimed to investigate the predictive value of parameters from a 3D visualization model based on preoperative computed tomography (CT) for the failure of FANS placement without pre-stenting. METHODS: We retrospectively analyzed the clinical data of 113 patients who underwent RIRS at Chengdu Hospital of Integrated Traditional Chinese and Western Medicine. A 3D visualization model was constructed based on preoperative CT data to measure the lateral ureteral angle, intramural ureteral diameter, intramural ureteral length and pelvic ureteral diameter. A predictive model for failure of FANS placement without pre-stenting was established after univariate and multivariate analyses, and the model performance was evaluated by bootstrap internal validation, calibration curves, decision curve analysis (DCA) etc. RESULTS: Among the 113 patients, significant intergroup differences were observed between the successful placement group (n = 96) and the failed placement group (n = 17) in age (P = 0.010), lateral ureteral angle (P = 0.018), intramural ureteral diameter (P < 0.001) and pelvic ureteral diameter (P = 0.008). No significant intergroup differences were found in body mass index (BMI), stone CT value, stone size, stone number, gender, hydronephrosis, history of ipsilateral lithotripsy, preoperative fever history or intramural ureteral length (P > 0.05). Multivariate analysis identified intramural ureteral diameter (OR = 0.06, 95% CI: 0.01~ 0.29, P < 0.001) and pelvic ureteral diameter (OR = 0.26, 95% CI: 0.08 ~ 0.78, P = 0.017) as protective factors against placement failure, while the lateral ureteral angle (OR = 1.17, 95% CI: 1.04 ~ 1.31, P = 0.006) was a risk factor for placement failure. Due to sample size limitations, the lateral ureteral angle and intramural ureteral diameter were included in the predictive model based on the Bayesian information criterion (BIC). The area under the curve (AUC) of the model was 0.852 (95% CI: 0.763 ~ 0.941), and the AUC of internal validation via Bootstrap resampling (n = 1000) was 0.846 (95% CI: 0.808 ~ 0.860). CONCLUSIONS: The intramural ureteral diameter and lateral ureteral angle measured by the 3D visualization model based on preoperative CT are powerful predictors for the failure of FANS placement without pre-stenting. The constructed predictive model exhibits good performance. However, further validation with multi-center and large-sample studies is still required.
Massive bleeding from a Bricker ileal conduit during FOLFIRINOX therapy in noncirrhotic portal hypertension: suspected oxaliplatin-associated sinusoidal injury and presumed irinotecan-associated conduit mucositis: a case report.
Drobot RB, Ślósarz T, Antoniewicz AA
BMC Urol · 2026 May · PMID 42215991 · Full text
BACKGROUND: Bleeding from an ileal conduit after radical cystectomy is uncommon and is usually attributed to tumor recurrence, infection, stones, or local stomal trauma. Portal hypertensive stomal varices are rare. FOLFI...
BACKGROUND: Bleeding from an ileal conduit after radical cystectomy is uncommon and is usually attributed to tumor recurrence, infection, stones, or local stomal trauma. Portal hypertensive stomal varices are rare. FOLFIRINOX adds further diagnostic complexity because oxaliplatin may cause sinusoidal endothelial injury and noncirrhotic portal hypertension, whereas irinotecan may damage gastrointestinal mucosa. We report a case of massive hemorrhage from a long-functioning Bricker ileal conduit during FOLFIRINOX therapy. CASE PRESENTATION: A 72-year-old man with prior radical cystoprostatectomy with Bricker diversion in 2022, robot-assisted left adrenalectomy in 2023, and pancreatic head adenocarcinoma treated with FOLFIRINOX was admitted in February 2026 because of sudden gross hematuria that rapidly filled the urostomy bag with blood and clot. He had received two FOLFIRINOX cycles. With a height of 170 cm and weight of 70 kg, body-surface area was 1.82 m² by the Mosteller formula. Using the standard FOLFIRINOX oxaliplatin dose of 85 mg/m², the reconstructed cumulative oxaliplatin exposure was approximately 170 mg/m², corresponding to about 310 mg in total. Bleeding began 8 days after the most recent irinotecan-containing cycle. Contrast-enhanced computed tomography showed periportal tumor-related changes with a biliary stent, variceal collaterals adjacent to the conduit, and circumferential thickening of the conduit wall, whereas the upper urinary tracts were nondilated and there was no radiologic evidence of recurrent urothelial carcinoma. Looposcopy demonstrated diffusely inflamed and friable conduit mucosa, but biopsy was not performed. Doppler ultrasonography demonstrated portal vein dilatation with preserved hepatopetal flow and no imaging features of cirrhosis. Platelet counts remained within the reference range, and retrospective review of restaging computed tomography showed no interval splenomegaly; the craniocaudal splenic length was approximately 11 cm and unchanged. Urine culture grew extended-spectrum beta-lactamase-producing Escherichia coli and Enterococcus faecalis, but inflammatory markers remained low and there were no clinical features of sepsis. The most cautious interpretation was a mixed mechanism: portal hypertensive stomal varices, possibly related to pancreatic venous distortion and/or early oxaliplatin-associated sinusoidal injury, compounded by presumed irinotecan-associated conduit mucositis. Bleeding ceased with supportive, anti-inflammatory, antimicrobial, transfusion, and nonselective beta-blocker therapy. By May 2026, conduit bleeding had not recurred, although the patient remained chronically unwell with poor ECOG performance status because of the underlying pancreatic cancer. CONCLUSIONS: Massive bleeding from a Bricker conduit during FOLFIRINOX therapy may be multifactorial. Early portal-phase imaging and portal venous assessment are essential when hemorrhage is disproportionate to routine urinary tract findings. In the absence of histology, catheter venography, and portal pressure measurement, causal language should remain cautious. If bleeding recurs, management should move beyond local measures and consider venous mapping, targeted embolization or sclerotherapy, portal decompression or venous stenting in suitable anatomy, and surgical undiversion to bilateral cutaneous ureterostomies when durable conduit preservation appears unlikely.
Correction: Efficacy and safety of mirabegron versus solifenacin in the treatment of overactive bladder in children: a systematic review and meta-analysis.
Shaheen M, Ali OM, Draz AA … +10 more , Barakat AK, Elghattas A, Elbaz T, Walid I, Tarboush T, Elsayed A, Mahmoud T, Elkhateeb EM, Nofal AA, Samaan E
BMC Urol · 2026 May · PMID 42215984 · Full text
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Association between hepatitis C virus and overactive bladder: a cross-sectional study based on the 2013-2018 NHANES.
Ding Y, Zhao T, Ji J … +6 more , Wang Z, Zhang D, Ye Z, Chen M, Mao W, Wu J
BMC Urol · 2026 May · PMID 42215955 · Full text
BACKGROUNDS: Overactive bladder (OAB) is a common urological disorder with an incompletely understood pathogenesis that markedly impacts patients' quality of life, and hepatitis C virus (HCV) infection is associated with...
BACKGROUNDS: Overactive bladder (OAB) is a common urological disorder with an incompletely understood pathogenesis that markedly impacts patients' quality of life, and hepatitis C virus (HCV) infection is associated with systemic inflammation and extrahepatic complications, with their potential association remaining understudied. This study thus aims to investigate the association between HCV and OAB in adults. This study aims to investigate the association between hepatitis C virus (HCV) and overactive bladder (OAB) in adults. METHODS: This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2018. Logistic regression analysis, subgroup analysis, and interaction tests were employed to assess the association between HCV and OAB. Additionally, propensity score matching (PSM), inverse probability weighting (IPTW), and overlap weighting (OW) were employed to control for confounding factors. E-value analysis was conducted to assess the robustness of results against unmeasured confounders, while sensitivity and specificity analyses evaluated the predictive performance of HCV for OAB. RESULTS: This study included 14,012 patients aged ≥ 20 years. Logistic regression analysis demonstrated an association between HCV and OAB (OR = 2.06, 95% CI 1.46-2.90, p < 0.001). Subgroup analyses and interaction tests confirmed that the relationship between HCV and OAB remained consistent across all subgroups (all interaction P values > 0.05). After PSM, IPTW, and OW analyses, the association between the two remained significant; E-value analysis demonstrated strong robustness to unmeasured confounders; Sensitivity and specificity results indicate that HCV has predictive value for OAB. CONCLUSIONS: The findings of this study indicate that there is a significant correlation between HCV and OAB.
CT and MRI features of renal inflammatory myofibroblastic tumor and its differential diagnosis from clear cell renal cell carcinoma and chromophobe renal cell carcinoma: a study of 13 cases from two centers.
Du H, Wu J, Shen Q … +6 more , Rong C, Wang K, Liu J, Qiu J, Wang H, Qin N
BMC Urol · 2026 May · PMID 42210207 · Full text
BACKGROUND: To compare the CT and MRI features of renal inflammatory myofibroblastic tumor (IMT) with those of clear cell renal cell carcinoma (ccRCC) and chromophobe renal cell carcinoma (ChRCC). METHODS: Clinical and i...
BACKGROUND: To compare the CT and MRI features of renal inflammatory myofibroblastic tumor (IMT) with those of clear cell renal cell carcinoma (ccRCC) and chromophobe renal cell carcinoma (ChRCC). METHODS: Clinical and imaging data of 13 patients with pathologically confirmed renal IMT, along with 52 patients with ccRCC and 52 with ChRCC treated at two centers between January 2013 and February 2025 were retrospectively obtained, and the lesions' location, shape, margin, size, secondary changes, density or signal characteristics, and enhancement degree with pattern were analyzed. The clear cell likelihood score (ccLS) was used for the evaluation of MRI characteristics. RESULTS: The renal IMT cohort comprised 9 males and 4 females (mean age, 54.2 ± 8.61 years). All lesions were solitary, measuring 1.7-14.4 cm. Notably, ill-defined margins were detected in 9/13 (69.2%), perirenal fascia thickening in 8/13 (61.5%), and non-enhancing region in 3/13 (23.1%). There was no hemorrhage, central scar or calcification. Unenhanced CT showed a mean attenuation of 43.7 HU. On contrast-enhanced CT, 77.8% (7/9) exhibited mild-moderate enhancement, with 55.6% (5/9) showing progressive enhancement and 33.3% (3/9) demonstrating a "slow-in and slow-out" pattern. MRI revealed hypointense or isointense signal on T1WI and T2WI, while 87.5% (7/8) showed restricted diffusion on DWI and arterial-to-delayed enhancement ratio < 1.5. No lesions exhibited microscopic fat or segmental enhancement inversion. The ccLS for renal IMTs were predominantly 1-2. Compared to ccRCCs and ChRCCs, renal IMTs more commonly exhibited ill-defined margins (P1 = 0.037, P2 < 0.001), perirenal fascia thickening (P1 = 0.014, P2 < 0.001) and higher unenhanced CT attenuation (P1 = 0.016, P2 = 0.030). Two renal IMT cases showed suspected postoperative recurrence or metastasis. CONCLUSIONS: CT and MRI imaging features can facilitate the diagnosis of renal IMT and differentiate it from ccRCC and ChRCC.
Clinical and imaging predictors of urachal carcinoma: the role of gross hematuria and calcification in a single-center retrospective study.
Thai KL, Le PND, Nguyen TT … +1 more , Ngo XT
BMC Urol · 2026 May · PMID 42204692 · Full text
BACKGROUND: Urachal anomalies are rare entities in the adult population with significant malignant potential. This study aims to comprehensively describe clinical and paraclinical characteristics, as well as to analyze a...
BACKGROUND: Urachal anomalies are rare entities in the adult population with significant malignant potential. This study aims to comprehensively describe clinical and paraclinical characteristics, as well as to analyze and evaluate prognostic factors for urachal carcinoma, thereby facilitating early diagnosis and effective management. METHODS: We conducted a retrospective study on patients diagnosed with urachal anomalies from 2017 to 2025. Data regarding clinical characteristics, imaging findings, treatment modalities, and clinical outcomes were collected for both benign and malignant cases. Additionally, survival outcomes were specifically analyzed for patients with urachal carcinoma. RESULTS: A total of 112 patients were included, comprising 8.9% cases of urachal carcinoma, while infection was the predominant presentation (72.3%). Surgical management differed significantly by pathology, with urachal excision and partial cystectomy performed in 80.0% of malignant cases versus 23.9% of benign cases. Multivariate logistic regression identified hematuria (Odds Ratio (OR) 14.1; 95% Confidence Interval (CI) 1.3-153.6; p = 0.03) and calcification (OR 13.5; 95% CI 1.7-109.2; p = 0.01) as significant independent predictors of malignancy. Histologically, adenocarcinoma was the major subtype (80%), with most tumors being Sheldon stage IIIA or IV. Overall survival (OS) showed a steep decline, recorded at 90.0%, 60.0%, and 15.0% at 1, 3, and 5 years, respectively. CONCLUSIONS: Gross hematuria and calcification serve as critical, independent predictors of urachal malignancy. Given the aggressive nature and poor overall prognosis (5-year OS of only 15.0%), the presence of these indicators necessitates an aggressive diagnostic workup and prompt radical surgical intervention (en-bloc urachal excision with partial cystectomy) to optimize long-term patient outcomes.
Overcoming surgical challenges with robotic assistance: robot-assisted nephrectomy of a failed renal allograft after complex en-bloc dual kidney transplantation.
Yang X, Zhang Z, Shi W … +5 more , Zhu H, Zhang W, Zhang S, Zhang Q, Hou X
BMC Urol · 2026 May · PMID 42192503 · Full text
We present the case of a 37-year-old male who underwent infant donor en-bloc dual kidney transplantation (EBKT) and subsequently developed left allograft failure with severe refractory urinary tract infection secondary t...
We present the case of a 37-year-old male who underwent infant donor en-bloc dual kidney transplantation (EBKT) and subsequently developed left allograft failure with severe refractory urinary tract infection secondary to long-standing ureteropelvic junction obstruction and hydronephrosis. After failure of conservative anti-infective therapy to control recurrent infection, the patient underwent successful robot-assisted extracapsular allograft nephrectomy (ECAN), with the primary surgical indication of eradicating the source of refractory infection in the obstructed, completely non-functional allograft. The procedure was completed in 145 min with minimal blood loss (20 mL). The patient was discharged on postoperative day 5 with complete resolution of symptoms and preserved function of the contralateral viable graft. This case demonstrates that robot-assisted surgery offers a safe and precise surgical option for failed allograft nephrectomy after complex pediatric EBKT, with favorable perioperative outcomes in this specific scenario involving distorted anatomy and severe adhesions.
Aggressive chronic prostatitis mimicking locally advanced prostate cancer with apparent extraprostatic extension: a case report.
Ozdemir O
BMC Urol · 2026 May · PMID 42192391 · Full text
BACKGROUND: Multiparametric prostate MRI (mpMRI) is widely used for prostate cancer detection and local staging. Imaging features such as marked diffusion restriction, intense contrast enhancement, and apparent extrapros...
BACKGROUND: Multiparametric prostate MRI (mpMRI) is widely used for prostate cancer detection and local staging. Imaging features such as marked diffusion restriction, intense contrast enhancement, and apparent extraprostatic extension are typically associated with aggressive malignancy. However, inflammatory conditions may rarely mimic locally advanced prostate cancer, potentially leading to overstaging and inappropriate treatment. CASE PRESENTATION: A 49-year-old man presented with nonspecific lower urinary tract symptoms and a serum prostate-specific antigen level of 2.7 ng/mL. mpMRI revealed a large mass-like peripheral zone lesion with marked diffusion restriction, rapid early enhancement, and imaging features suggestive of extraprostatic extension, leading to a PI-RADS 5 assessment and suspicion of locally advanced prostate cancer. Despite aggressive imaging findings, systematic biopsy demonstrated chronic prostatitis without malignancy. Following antibiotic therapy, short-term follow-up mpMRI showed marked regression of the lesion with resolution of diffusion restriction and contrast enhancement, confirming an inflammatory etiology. CONCLUSIONS: Aggressive chronic prostatitis may closely mimic locally advanced prostate cancer on mpMRI, including apparent extraprostatic extension. Recognition of this diagnostic pitfall and careful radiologic-clinical correlation are essential to avoid overstaging and unnecessary definitive treatment.
Could miRNAs be used as markers for distinguishing undescended testes from retractile testes? A prospective controlled pilot/exploratory study.
Keleş M, Benli E, Ergün S … +6 more , Çırakoğlu A, Yazıcı İ, Kadim N, Noyan T, Demir D, Sılay MS
BMC Urol · 2026 May · PMID 42192354 · Full text
BACKGROUND: Undescended testes (UDTs) are common in male infants. Untreated UDT poses risks such as infertility (IF), testicular cancer (TC), and testicular torsion (TT). Retractile testes (RTs) sporadically ascend from...
BACKGROUND: Undescended testes (UDTs) are common in male infants. Untreated UDT poses risks such as infertility (IF), testicular cancer (TC), and testicular torsion (TT). Retractile testes (RTs) sporadically ascend from the scrotum. UDT requires early surgical correction, whereas RT requires only periodic follow-up. Differentiating these conditions is challenging, making clinical biomarkers potentially useful. The aim of our study was to examine the use of miRNAs as biomarkers in the differential diagnosis of UDT and RT which are difficult to differentiate. METHODS: This prospective pilot/exploratory study included 10 boys with UDT (operated), 9 with RT (followed), and 9 controls. Only palpable (unilateral or bilateral) UDT cases were included, excluding nonpalpable types. To ensure accurate RT diagnosis, initial physician examinations were performed in three positions (supine, semi-supine, standing), followed by a 1-month parental examination (twice daily). Only RT patients whose testes spent > 50% of their time in the scrotum were included. The exclusion criteria also included prior inguinal/scrotal surgery, defective datasets, or unsuitable serum samples. Parent consent and serum samples were collected to evaluate miR-210, miR-34c, and miR-449a expression via real-time PCR. RESULTS: Statistical analysis revealed no significant difference in miR-34c (p = 0.157) or miR-210 (p = 0.950) expression. However, the miR-449a level differed significantly between the groups (p = 0.033). Dunn-Bonferroni post hoc correction revealed significantly greater miR-449a in the RT group than in the UDT group (p < 0.05). No difference in miR-449a expression was found between the control and UDT groups (p > 0.05). Serum miR-449a demonstrated significant diagnostic potential in differentiating UDT from retractile testis (AUC: 0.822, p = 0.017) with 90.0% sensitivity and 77.8% specificity. These findings suggest that miR-449a could serve as a promising non-invasive biomarker to distinguish true undescended testis from its clinical mimics. CONCLUSIONS: Serum miRNA levels represent a potential tool for differentiating UDT from RT. Our pilot/exploratory study partially corroborates this, but comprehensive prospective randomized trials with larger cohorts are essential to definitively clarify miRNA alterations for precise distinction. TRIAL REGISTRATION: This prospective case-control study was registered to clinicaltrials.gov database, 'retrospectively'. The trial registration number is: NCT07315737, the unique protocol ID is: 2022/25.
Lack of real-world evidence on active surveillance in Chinese patients with prostate cancer: insights from a 10-year cohort and a physician survey.
Xian P, Li P, Yuan G … +8 more , Dai J, Yuan F, Song Y, Zhu D, Zhang T, Lei H, Li J, Liu N
BMC Urol · 2026 May · PMID 42186046 · Full text
BACKGROUND: Active surveillance (AS) is an established management strategy for low-risk prostate cancer (PCa). However, its real-world implementation in China remains limited. This study aimed to present the outcomes of...
BACKGROUND: Active surveillance (AS) is an established management strategy for low-risk prostate cancer (PCa). However, its real-world implementation in China remains limited. This study aimed to present the outcomes of patients with early-stage PCa undergoing AS and to identify the main obstacles encountered in the promotion of AS. METHODS: We conducted a two-part study consisting of a prospective observational cohort of patients who elected for AS at a tertiary cancer center (2012-2017) and a nationwide cross-sectional survey of urologists assessing their knowledge, attitudes, and practice patterns regarding AS. Clinical outcomes, adherence to follow-up, and treatment conversion were evaluated in the cohort. Survey responses were analyzed across hospital level and physician seniority. RESULTS: Among the 452 patients with localized PCa evaluated during the study period, 20 met the eligibility criteria and selected AS. After a median follow-up period of 118 months, 13 patients transitioned to definitive treatment, most commonly because of suspected disease progression. Three deaths occurred, one of which was a PCa-specific death. Adherence to scheduled PSA monitoring was high, whereas repeat biopsy compliance was low. The survey included 343 valid physician responses. Familiarity with AS eligibility and follow-up protocols was significantly higher among physicians in academic hospitals and those with senior titles. However, < 10% reported having structured AS follow-up programs, and most perceived patient anxiety and preference for surgery as major barriers to AS implementation. CONCLUSIONS: AS may be a feasible management option for carefully selected Chinese patients. Efforts to expand AS use in China should prioritize patient education, structured follow-up systems, national registry development, and supportive health policy measures.
HSF4 promotes renal cell carcinoma progression and is associated with PI3K/Akt pathway.
Li Y, Xie H, Dong C … +13 more , Yu T, Wu S, Cui X, Xiang C, Tao H, Liang N, Guo J, Yang Y, Yang J, Li X, Cha J, Wang W, Lin C
BMC Urol · 2026 May · PMID 42185995 · Full text
BACKGROUND: Renal cell carcinoma (RCC) is a common urological malignancy, accounting for approximately 2% of global cancer-related mortality. Heat shock factors (HSFs) are transcription factors that regulate cell stress...
BACKGROUND: Renal cell carcinoma (RCC) is a common urological malignancy, accounting for approximately 2% of global cancer-related mortality. Heat shock factors (HSFs) are transcription factors that regulate cell stress reaction. However, the exact mode of action of HSF4 in cancer, particularly RCC, is still unknown. OBJECTIVE: To investigate the expression pattern of HSF4 in RCC and its potential molecular mechanism (especially the association with the PI3K/Akt pathway), so as to identify a new therapeutic target for RCC. METHODS: Bioinformatics analyses were performed to assess HSF4 expression and its prognosis relevance in RCC. The effects of HSF4 on RCC were studied with both in vitro and in vivo experiments. The transcriptome sequencing results were analyzed for both the gene knockdown and control RCC cells to predict relevant RCC signaling pathways. RESULTS: Our experimental results indicate that HSF4 knockdown can prevent the occurrence and spread of RCC in the body, as well as the growth and invasion of RCC cells. Mechanistically, HSF4 knockdown led to a significant decrease in the protein levels of PI3K, p-AKT, β-catenin, and c-Myc. These findings demonstrate that HSF4 promotes RCC progression by concurrently activating the PI3K/AKT and Wnt/β-catenin signaling pathways. CONCLUSION: Our findings identify that HSF4 is highly expressed in RCC and can promote the occurrence and development of RCC. Therefore, HSF4 may be a potential therapeutic target for RCC.
Bladder-sparing chemoradiotherapy following neoadjuvant chemotherapy for muscle-invasive bladder cancer: a retrospective cohort study.
Mofid B, Jafari A, Simforoosh N … +6 more , Basiri A, Siavashpour M, Siavashpour Z, Zabihi MS, Ghajari M, Razzaghdoust A
BMC Urol · 2026 May · PMID 42185887 · Full text
PURPOSE: Radical cystectomy following cisplatin-based neoadjuvant chemotherapy (NAC) is still the standard approach for managing muscle-invasive bladder cancer (MIBC); however, a substantial proportion of patients are no...
PURPOSE: Radical cystectomy following cisplatin-based neoadjuvant chemotherapy (NAC) is still the standard approach for managing muscle-invasive bladder cancer (MIBC); however, a substantial proportion of patients are not candidates for surgery or cisplatin-based chemotherapy. The role of NAC followed by chemoradiation (CRT) in a bladder-preserving approach is not well established. This study aimed to evaluate the feasibility, survival outcomes, and prognostic factors associated with NAC followed by definitive CRT. MATERIALS AND METHODS: We retrospectively analyzed MIBC patients treated with NAC and subsequent CRT between 2010 and 2023. Overall survival (OS) and event-free survival (EFS) were analyzed using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: Among 224 MIBC patients treated with NAC, 132 patients received bladder-preserving CRT after NAC. The median OS for the entire cohort was 58 months (95% CI: 37.63-78.37). Median OS was significantly longer in patients with clinical complete response (cCR) compared with those without (73 vs. 29 months, p = 0.007). Median EFS was also superior in the cCR group (50 vs. 23 months, p = 0.022). In multivariable Cox regression analysis, achievement of cCR was independently associated with superior OS (HR 0.52, 95% CI 0.30-0.92, p = 0.028) and EFS (HR 0.54, 95% CI 0.32-0.93, p = 0.036). Moreover, the presence of baseline hydronephrosis predicted significantly worse OS (HR 2.37, 95% CI 1.32-4.25, p = 0.006) but showed no association with EFS. The type of NAC regimen (cisplatin vs. carboplatin) had no independent effect on survival. CONCLUSION: NAC followed by CRT is a feasible bladder-preserving approach for selected patients with MIBC, including those ineligible for cystectomy or cisplatin. Achievement of cCR is the most robust prognostic factor for both OS and EFS, supporting its role as a surrogate endpoint in this setting. These findings provide novel evidence for integrating NAC into bladder-preserving strategies and highlight clinical factors that may guide individualized treatment selection. A prospective randomized trial is warranted.
Ureteral wall thickness as an imaging-based predictor of difficult ureter during ureteroscopic lithotripsy: a retrospective analysis.
Chen Y, Zhang J, Li L … +3 more , Shen Y, Guo X, Li G
BMC Urol · 2026 May · PMID 42185823 · Full text
OBJECTIVE: To evaluate the value of ureteral wall thickness (UWT) obtained from non-contrast computed tomography (NCCT) for predicting difficult ureter (DU) among patients receiving ureteroscopic lithotripsy (URS). METHO...
OBJECTIVE: To evaluate the value of ureteral wall thickness (UWT) obtained from non-contrast computed tomography (NCCT) for predicting difficult ureter (DU) among patients receiving ureteroscopic lithotripsy (URS). METHODS: Patients with unilateral ureteral stones managed by URS were retrospectively reviewed. According to intraoperative findings, they were classified into DU or non-DU group. UWT was measured at the level of the stone on preoperative NCCT. Multivariate logistic regression was used to identify independent predictors. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff value of UWT for predicting DU. RESULTS: A total of 271 patients managed with URS were enrolled in the study, with 67 (24.72%) in the DU group and 204 (75.28%) in the non-DU group. The mean UWT in the DU group was 3.77 ± 1.24 mm, which was significantly higher than that in the non-DU group. Multivariate logistic regression revealed that UWT was an independent risk factor for DU, with an OR of 2.139 (95% CI: 1.634-2.79). The ROC curve demonstrated that a UWT cutoff of 2.9 mm provided the best threshold for predicting DU, with sensitivity and specificity levels of 77.6% and 71.6%, with an area under the ROC curve (AUC) of 0.786. Moreover, a UWT greater than 2.9 mm was associated with abnormal endoscopic findings during surgery, prolonged operative time, and a reduced stone-free rate. CONCLUSION: UWT is an independent risk factor for DU. Preoperative measurement of UWT holds significant value in predicting DU. These findings may assist in surgical planning before URS.
Comparison of suction and standard ureteral access sheath versus sheathless flexible ureteroscopy in management of upper ureteral and renal calculi.
Zanaty F, Ali M, Elserafy F … +1 more , Abozaid M
BMC Urol · 2026 May · PMID 42178535 · Full text
PURPOSE: Comparative effectiveness of suction versus traditional ureteral access sheath (UAS) remains an area of ongoing research. We aim to compare the outcomes of retrograde intrarenal surgery (RIRS) with suction and s...
PURPOSE: Comparative effectiveness of suction versus traditional ureteral access sheath (UAS) remains an area of ongoing research. We aim to compare the outcomes of retrograde intrarenal surgery (RIRS) with suction and standard UAS versus without UAS in the management of renal and upper ureteric stones, with a specific focus on operative efficiency, stone-free rates, and postoperative complications. METHODS: This study was conducted between October 2023 and January 2025, including 90 patients with renal stones ≤ 3 cm and upper ureteric stones ≤ 1.5 cm. Patients were divided into three groups by random Allocation Software (version 2): Group A1 (standard UAS, n = 30), Group A2 (suction UAS, n = 30), and Group B (no UAS, n = 30). Operative time, vision quality, stone clearance, complications, and hospital stay were assessed. RESULTS: Group A2 had the shortest mean operative time (70.1 ± 10.3 min) with significantly better vision compared to Group A1 (114.3 ± 27.0 min) and Group B (125.0 ± 28.01 min) (p < 0.001). Residual stone rates were lowest in Group A2 (3.3%) compared to Group A1 (10.0%) and Group B (26.7%) (p = 0.035). The need for a second procedure was significantly higher in Group B (26.7%) compared to Group A1 (10.0%) and absent in Group A2 (p = 0.002). Hospital stay was significantly shorter in Group A2 compared to Group A1 and Group B (p = 0.005). Fever incidence (Clavien Grade II) was significantly higher in Group B (23.3%) compared to Group A1 (16.7%) and absent in Group A2 (p = 0.005). CONCLUSION: Suction ureteral access sheaths in flexible ureteroscopic lithotripsy for renal stones ≤ 3 cm and upper ureteric stones ≤ 1.5 cm was associated with improved stone clearance, reduced operative time and hospital stay, provide better endoscopic vision, minimized infectious complications and need for second procedure, compared to standard UAS or no sheath. However, outcomes may be influenced by surgeon experience and familiarity with suction-assisted systems. Prospective multicenter studies with larger sample sizes and varying surgeon experience levels are recommended.
Voiding dysfunction in pelvic organ prolapse mimicking obstruction: an unusual presentation of sacral chordoma - A case report.
Saraluck A, Harncharoenkul P, Wattanayingcharoenchai R
BMC Urol · 2026 May · PMID 42177451 · Full text
BACKGROUND: Pelvic organ prolapse (POP) is commonly associated with voiding dysfunction, often presumed to result from bladder outlet obstruction. However, neurological or structural lesions may mimic or coexist with pro...
BACKGROUND: Pelvic organ prolapse (POP) is commonly associated with voiding dysfunction, often presumed to result from bladder outlet obstruction. However, neurological or structural lesions may mimic or coexist with prolapse-related dysfunction. Sacral chordoma is a rare malignant tumor that can compress sacral nerves and present with lower urinary tract symptoms. CASE PRESENTATION: We describe a 71-year-old multiparous Thai woman with stage II POP and mild lower urinary tract symptoms, including occasional stress incontinence, rare urgency, and mild voiding difficulty, initially not affecting her quality of life. She also reported constipation, which improved with dietary changes. Pessary use was discontinued due to discomfort, and surgical management for POP was subsequently considered. Five months later, she developed progressive urinary retention requiring Foley catheterization. Urodynamics revealed normal bladder sensation and compliance but absent detrusor contractions, with residual volume of ~ 550 mL, consistent with acontractile detrusor. Initial pelvic MRI demonstrated a 10.0 × 6.7 × 9.4 cm sacral/presacral mass involving S1-S3 vertebrae and sacral foramina. Biopsy confirmed conventional chordoma. Planned colpocleisis was cancelled, and the patient was referred for multidisciplinary care. En bloc resection was not feasible; proton beam radiotherapy was initiated. Bladder management required chronic catheterization, while constipation was treated conservatively. At follow-up, POP remained but was less distressing compared with tumor-related symptoms. CONCLUSIONS: This case highlights an unusual neurourological presentation of sacral chordoma in a woman with POP. It emphasizes that not all voiding dysfunction in prolapse results from obstruction. Atypical findings, especially detrusor underactivity, should prompt further imaging to exclude neurological or structural causes. Comprehensive preoperative evaluation, including urodynamic studies, is essential in patients with pelvic organ prolapse and suspected detrusor underactivity to ensure accurate diagnosis and to avoid inappropriate surgical intervention, in line with current clinical guidelines. Early recognition prevents misdiagnosis and inappropriate surgery.
When double-J stents become a risk: bilateral distal ureteric urothelial carcinoma following ureteric instrumentation: a case report.
Eldesouki S, Elmekresh A, Esmaeilpour H … +4 more , Kumar S, Alsel KA, Azad EM, Bagheri F
BMC Urol · 2026 May · PMID 42174561 · Full text
BACKGROUND: Metachronous upper tract urothelial carcinoma (UTUC) is an uncommon but clinically significant event in patients with non-muscle-invasive bladder cancer (NMIBC), particularly in those with high-risk or recurr...
BACKGROUND: Metachronous upper tract urothelial carcinoma (UTUC) is an uncommon but clinically significant event in patients with non-muscle-invasive bladder cancer (NMIBC), particularly in those with high-risk or recurrent disease. Proposed mechanisms include field cancerization and intraluminal tumor seeding, while ureteric instrumentation has been discussed as a potential contributing factor. Emerging evidence suggests that retrograde ureteric stent placement performed concurrently with transurethral resection of bladder tumor (TURBT) may be associated with an increased risk of subsequent upper tract involvement. We report the first case of bilateral distal ureteric urothelial carcinoma developing in close temporal association with first-time ureteric stent placement in a patient with recurrent NMIBC. CASE REPORT: A 78-year-old man with recurrent high-grade NMIBC underwent bilateral ureteric stent placement during TURBT for obstructive uropathy, with no prior evidence of UTUC. Within months, imaging demonstrated progressive distal ureteric abnormalities. Subsequent cystoscopy and bilateral ureteroscopy revealed extensive papillary tumors involving both distal ureters with proximal extension, in addition to recurrent bladder lesions. Histopathology confirmed high-grade, non-muscle-invasive urothelial carcinoma. At re-intervention, both indwelling stents were encased within tumor tissue. CONCLUSION: This case highlights the multifactorial nature of metachronous UTUC in patients with recurrent bladder cancer and supports the hypothesis that ureteric instrumentation may contribute to upper tract tumor dissemination in selected high-risk settings. Careful consideration of urinary diversion strategies and close upper tract surveillance remain important when managing patients with active bladder urothelial carcinoma.
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