BMC Urology[JOURNAL]
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200 papers
Neoadjuvant hormone therapy plus robot-assisted radical prostatectomy improves pathologic outcomes in high-risk prostate cancer: a retrospective cohort study.
Fan J, Liu S, Li Z … +7 more , Xv Y, Li T, Huang S, Feng C, Liu J, Li D, Jiang F
BMC Urol · 2026 Apr · PMID 42050599 · Full text
BACKGROUND: To assess the impact of neoadjuvant hormone therapy (NHT) prior to robot-assisted radical prostatectomy (RP) in high-risk prostate cancer (HRPCa). METHODS: We retrospectively analyzed 141 HRPCa patients who u...
BACKGROUND: To assess the impact of neoadjuvant hormone therapy (NHT) prior to robot-assisted radical prostatectomy (RP) in high-risk prostate cancer (HRPCa). METHODS: We retrospectively analyzed 141 HRPCa patients who underwent robot-assisted RP from February 2022 to June 2025. According to whether NHT was administered preoperatively, patients were divided into NHT + RP group (n = 27) and RP-alone group (n = 114). The perioperative parameters and pathological outcomes were compared between groups. RESULTS: At the baseline, the NHT + RP group had significantly higher fibrinogen (p = 0.003), AST (p = 0.034), PSA (p = 0.001), and PSA density (p < 0.001), indicating more aggressive disease. Even so, NHT + RP was associated with a trend toward reduced prostate volume (37.70 ± 31.14 vs. 46.07 ± 29.50 ml, p = 0.315) and improved pathological outcomes, including higher rates of pCR (18.5% vs. 0%, p < 0.001) and MRD (7.4% vs. 0%, p = 0.003), as well as a lower PSM rate (33.3% vs. 57.0%, p = 0.027). In multivariable analysis, NHT remained independently associated with reduced PSM (OR = 0.236, 95% CI: 0.068–0.820, p = 0.023). CONCLUSION: Preoperative NHT followed by robot-assisted RP in HRPCa improved key pathological outcomes, including higher pCR/MRD and lower PSM rates. Given the inherent limitations of the retrospective design, prospective studies are required to validate these findings and their long-term clinical benefit.
Anesthetic management of primary renal sarcoma with Mayo IV tumor thrombus using moderate hypothermic circulatory arrest and antegrade cerebral perfusion: a case report.
Huang Z, Chen S, Zhang G … +2 more , Lu L, Lin Y
BMC Urol · 2026 Apr · PMID 42050503 · Full text
BACKGROUND: Primary renal sarcomas in adults are rare, accounting for 1% of all renal tumors. They progress rapidly and are resistant to radiotherapy and chemotherapy. Currently, surgery is the only effective treatment....
BACKGROUND: Primary renal sarcomas in adults are rare, accounting for 1% of all renal tumors. They progress rapidly and are resistant to radiotherapy and chemotherapy. Currently, surgery is the only effective treatment. CASE PRESENTATION: A 49-year-old man was admitted with a left kidney mass and inferior vena cava (IVC) tumor thrombus extending into the right atrium (Mayo grade IV). He underwent laparoscopic radical nephrectomy and tumor thrombus removal under extracorporeal circulation with moderate hypothermic circulatory arrest (25 °C) and bilateral selective antegrade cerebral perfusion. This technique ensured minimal bleeding while providing effective protection for the brain and coagulation system. The total circulatory arrest time was 91 min, with stable cerebral oxygen saturation throughout. CONCLUSIONS: Moderate hypothermic circulatory arrest combined with bilateral antegrade cerebral perfusion, along with a multidisciplinary perioperative management strategy, ensured a favorable prognosis for this patient with a Mayo level IV tumor thrombus. This report aims to provide a reference for the perioperative management of patients with Mayo grade IV tumor thrombi.
Structured reporting of B-mode, color Doppler, and CEUS in testicular tumor assessment: a reader study with urologist ratings.
Schnitzer ML, Biechele G, Eckermann C … +12 more , Herr FL, Dascalescu C, Heimer M, Schwarze V, Marcon J, Lenhart M, Waldbillig F, Baier F, Clevert DA, Frölich MF, Rübenthaler J, Geyer T
BMC Urol · 2026 Apr · PMID 42032677 · Full text
PURPOSE: Structured reporting (SR) offers standardized radiological documentation, enhancing clarity and reproducibility. However, its role in contrast-enhanced ultrasound (CEUS) for testicular tumors remains underexplor...
PURPOSE: Structured reporting (SR) offers standardized radiological documentation, enhancing clarity and reproducibility. However, its role in contrast-enhanced ultrasound (CEUS) for testicular tumors remains underexplored. This study evaluates urologist-perceived clarity, completeness, and clinical usefulness of SR compared to free-text reporting (FTR). METHODS AND MATERIALS: In this retrospective, single-center study, 65 male patients with suspected testicular tumors underwent CEUS at LMU University Hospital. Reports were initially documented as FTRs by an experienced radiologist and later converted into SRs using Smart Reporting software. Four board-certified urologists independently assessed both formats using a structured questionnaire. Completeness, readability, trust, and impact on clinical decision-making were evaluated. Statistical analysis included McNemar’s test and the Wilcoxon signed-rank test, with α = 0.05. RESULTS: SRs significantly improved readability (97.3% vs. 10.0%, p < 0.001) and information extraction (98.8% vs. 91.9%, p < 0.001). However, completeness (56.9% vs. 60.8%, p = 0.427) and clinical decision support (85.7% vs. 84.9%, p = 0.152) were comparable. Trust in SRs was lower than in FTRs (4.92 vs. 5.22, p < 0.001), likely due to missing diagnostic parameters and retrospective SR generation. CONCLUSIONS: SR was associated with improved reporting clarity and consistency but did not outperform FTR in completeness or clinical decision-making. Interdisciplinary collaboration in template development and the integration of classification systems could improve SR’s diagnostic value. Future prospective, multicenter studies should assess real-time SR implementation and its potential impact on reporting quality, communication, and outcome-based endpoints in prospective settings. CLINICAL RELEVANCE/APPLICATION: Structured reporting in multiparametric testicular ultrasound including CEUS improved perceived readability and facilitated information access for referring clinicians. However, SR showed no clear advantage over free-text reporting regarding completeness or clinical decision-making. The lower clinician trust in SR highlights the need for clinically tailored templates developed in interdisciplinary collaboration. The broader clinical value of SR in testicular imaging should be confirmed in prospective real-time studies incorporating outcome-based and workflow-related endpoints.
Intraoperative reaction time of the surgeon during retrograde intrarenal surgery.
Şahin MF, Akgül M, Doğan Ç … +3 more , Özcan R, Altın E, Yazıcı CM
BMC Urol · 2026 Apr · PMID 42032642 · Full text
BACKGROUND: Reusable flexible ureteroscopes (rfURS) are costly and fragile equipment that can be easily damaged during surgery. We aimed to investigate the change in the surgeon's reaction time during retrograde intraren...
BACKGROUND: Reusable flexible ureteroscopes (rfURS) are costly and fragile equipment that can be easily damaged during surgery. We aimed to investigate the change in the surgeon's reaction time during retrograde intrarenal surgery (RIRS), which may be a risk factor for rfURS damage in prolonged cases. METHODS: The patients who underwent RIRS with rfURS by the same surgeon were prospectively included in the study and the collected data were retrospectively analyzed. A phone application program (Reflex Test 2.2.4) designed to evaluate the user's reaction time with visual color change was used to evaluate the reaction time. According to the application format, the surgeon had to press the square when the rectangle's color changed from red to blue. The surgeon's reaction time was evaluated just before the operation and then every 10 minutes of the surgery. RESULTS: A total of 109 patients were included in the study. The mean stone volume was 1050.4 ± 874.5 mm (62.9-3889.7). The procedure time increased significantly as the stone volume increased. The mean reaction time of the pre-procedure was 0.330 ± 0.059 seconds (s). 0,338 ± 0.053 s (10th min.), 0.342 + 0.057 s (20th min), 0.356 ± 0.061 s (30th min), 0.361 ± 0.047 s (40th min), 0.364 ± 0.042 s (50th min), 0.376 ± 0.046 s (60th min) and 0.384 ± 0.032 s (more than 70 min) for 10, 20, 30, 40, 50, 60 and more than 70 min, respectively. The sequential reaction times of the procedure demonstrated a significant difference (p < 0.001). CONCLUSION: Compared to the pre-procedure period, the surgeon's reaction time increased during the surgery. This result may indicate increased surgeon fatigue during extended procedures, and additional investigation of its possible clinical implications is needed.
Assessment of aminoglycosides and β-lactam resistance genes among uropathogens; a prospective-cross sectional study.
Khan J, Basharat N, Sadiq A … +6 more , Ali S, Khan H, Ali I, Bogale A, Al-Emam A, Hassan HM
BMC Urol · 2026 Apr · PMID 42032578 · Full text
Urinary tract infections (UTIs) represent a major public health challenge worldwide, accounting for millions of outpatient consultations and substantial healthcare expenditure annually. In this prospective cross-sectiona...
Urinary tract infections (UTIs) represent a major public health challenge worldwide, accounting for millions of outpatient consultations and substantial healthcare expenditure annually. In this prospective cross-sectional investigation conducted from February 2019 to January 2020 at a tertiary-care hospital in Islamabad, Pakistan, we examined the etiological agents of UTI, their antimicrobial susceptibility profiles, and the occurrence of the aminoglycoside resistance genes aac(6’)-Ib-cr and the β-lactam resistance genes blaTEM among 503 patients with suspected UTI. Culture-confirmed UTI was established in 127 patients (25.2%; 95% CI 21.5–29.3%), with markedly higher prevalence in females (33.6%) than males (16.8%; P < 0.001). Of these, 16 (12.6%) yielded polymicrobial growth. Gram-negative bacilli predominated (110/127 isolates, 86.6%), led by Escherichia coli (91/127, 71.7%), followed by Klebsiella spp. (9/127, 7.1%), Proteus spp. (6/127, 4.7%), and Pseudomonas spp. (4/127, 3.1%). Among Gram-negative isolates, susceptibility was highest to cefepime (75.8%) and cefoxitin (68.1%), whereas resistance exceeded 65% against gentamicin, ampicillin, ceftriaxone, and ciprofloxacin, with 68.1% classified as multidrug-resistant. Gram-positive isolates retained full susceptibility to imipenem and vancomycin. These findings underscore the urgent requirement for routine culture-guided therapy, enhanced antimicrobial stewardship, and continuous local surveillance to mitigate the emergence of untreatable uropathogens.
Contrast-enhanced ultrasonography as an adjunct to angiography for renal arterial bleeding: a four-case series.
Lee J, Kim Y, Yi KS … +2 more , Choi CH, Cho BS
BMC Urol · 2026 Apr · PMID 42032575 · Full text
BACKGROUND: Renal artery bleeding is an uncommon but clinically important complication of surgery, percutaneous procedures, and trauma. Computed tomography (CT) is commonly used; however, indeterminate findings or concer...
BACKGROUND: Renal artery bleeding is an uncommon but clinically important complication of surgery, percutaneous procedures, and trauma. Computed tomography (CT) is commonly used; however, indeterminate findings or concerns regarding iodinated contrast can delay hemostasis in some cases. Bedside contrast-enhanced ultrasonography (CEUS) may provide real-time information to support triage to angiography and embolization. CASE PRESENTATION: We describe four hemodynamically stable patients: post-nephrectomy, post-percutaneous nephrolithotomy, post-biopsy, and blunt trauma. CT was indeterminate in two cases and deliberately omitted in two cases to avoid delay or contrast exposure. CEUS demonstrated focal contrast pooling, pooling with associated leakage, or jet-like extravasation, helping to localize the suspected culprit branch and supporting subsequent digital subtraction angiography. Superselective coil embolization achieved angiographic stasis in all patients, with no rebleeding during the index admission. Follow-up CEUS at 48 h demonstrated findings consistent with hemostasis, and interval CT showed expected hematoma evolution without residual pseudoaneurysm. CONCLUSION: CEUS served as a bedside adjunct decision-support tool across diverse etiologies when CT results were equivocal or deferred, facilitating angiography referral and potentially contributing to timely hemostasis while preserving uninvolved renal parenchyma. This case series demonstrates concordant findings between CEUS and angiography and supports the potential role of CEUS-guided triage for acute renal arterial bleeding.
Analysis of preoperative risk factors for clinical decision-making in female upper urinary tract stones: a retrospective cohort study.
Mo Z, Xu B, Chen Y … +4 more , Liang P, Fu Y, Gao X, Ruan Y
BMC Urol · 2026 Apr · PMID 42026581 · Full text
OBJECTIVE: To identify independent risk factors that can be used for the preoperative prediction of treatment complexity in female patients with upper urinary tract stones, thereby providing a basis for clinical decision...
OBJECTIVE: To identify independent risk factors that can be used for the preoperative prediction of treatment complexity in female patients with upper urinary tract stones, thereby providing a basis for clinical decision-making. METHODS: This single-center retrospective cohort study consecutively enrolled 219 female patients with upper urinary tract stones admitted to the Department of Urology between January 2024 and May 2025. Based on the occurrence of treatment complexity (including: ① preoperative ureteral stent placement due to infection or obstruction; ② ≥3 stone-related readmissions within 12 months; ③ hospital stay > 6 days), patients were categorized into a complex course group (n = 107) and a control group (n = 112). Preoperative clinical data were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Statistical analysis was performed using SPSS version 25.0. An exploratory preoperative risk stratification framework was proposed based on the results of multivariate analysis. RESULTS: Univariate analysis revealed significant differences between the two groups in age (P = 0.008), stone location (P < 0.001), stone area (P = 0.039), presence of bacteria/fungi (P < 0.001), acute renal insufficiency (P < 0.001), high-sensitivity C-reactive protein (hs-CRP) level (P = 0.001), procalcitonin (PCT) level (P < 0.001), body mass index (BMI), history of previous urological surgery, ureteral stenosis, bilateral stones, comorbid diabetes, hypertension, fatty liver, white blood cell count, absolute neutrophil count, and neutrophil percentage. Multivariate analysis identified four independent risk factors: [1] Stone location (using ureteral stones as reference, renal stones: OR = 6.67, 95% CI: 2.67–16.68, renal-ureteral stones: OR = 3.37, 95% CI: 1.29–8.80) [2]. Bacterial/fungal infection (OR = 3.30, 95% CI: 1.42–7.62) [3]. hs-CRP level (OR = 1.01, 95% CI: 1.00-1.02) [4]. PCT level (OR = 1.12, 95% CI: 1.01–1.23). Based on these findings, an exploratory preoperative risk stratification framework was proposed. In this framework, bacterial/fungal infection and renal stone location were categorized as high-risk factors, while hs-CRP ≥ 7.3 mg/L and PCT ≥ 0.65 ng/mL were categorized as intermediate-risk factors, pending external validation. CONCLUSION: Bacterial/fungal infection, stone location (renal stones), elevated hs-CRP, and elevated PCT are effective preoperative predictors of treatment complexity in female patients with upper urinary tract stones. The proposed exploratory risk stratification framework may aid in the identification of high-risk patients and offers preliminary evidence to support individualized surgical strategies and perioperative management plans, though prospective validation is required before clinical implementation.
Impact of comorbidity on patient reported outcome measures for men with localised prostate cancer.
Parry MG, Bailey AV, Belin TR … +12 more , Elashoff D, Foster C, Graham I, Kowalski C, Kwan L, Millar J, Sibert NT, Weller S, Wilhalme H, Litwin MS, Moore CM, TrueNTH Global Registry
BMC Urol · 2026 Apr · PMID 42001072 · Full text
BACKGROUND: Urinary and sexual function are impacted by prostate cancer treatment but also by comorbidities. We aimed to report the impact of comorbidities on functional outcomes after prostate cancer treatment. METHODS:...
BACKGROUND: Urinary and sexual function are impacted by prostate cancer treatment but also by comorbidities. We aimed to report the impact of comorbidities on functional outcomes after prostate cancer treatment. METHODS: We used patient reported EPIC-26, at baseline and 12 months, from a multicenter, prospective international cohort. Forest plots were constructed for urinary and sexual function, according to treatment, age and comorbidities (heart disease, hypertension and diabetes mellitus). RESULTS: We identified 10,928 patients diagnosed with non-metastatic prostate cancer with complete PROMs at baseline and at 12 months. Urinary and sexual function at baseline varied with age and comorbidities, but the biggest impact on 12-month function was the treatment itself. Surgery had a greater impact on urinary function compared to radiotherapy, irrespective of comorbidities, but this was only observed for sexual function in those with no comorbidities. Men of younger age and those with no comorbidities had the best preservation of urinary and sexual function after treatment, but a floor effect was observed whereby those with better baseline sexual function reported larger post-treatment differences. CONCLUSIONS: The impact of age and comorbidity on functional outcomes after prostate cancer treatment is minimal when considered against the impact of the treatment itself.
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 Apr · PMID 42001046 · Full text
BACKGROUND: Overactive bladder (OAB) affects 5–12% of children and is associated with urgency, frequency, and incontinence, often leading to psychosocial distress. Antimuscarinics are widely used but limited by systemic...
BACKGROUND: Overactive bladder (OAB) affects 5–12% of children and is associated with urgency, frequency, and incontinence, often leading to psychosocial distress. Antimuscarinics are widely used but limited by systemic side effects. Mirabegron, a β3-adrenoceptor agonist, may offer better tolerability. This review evaluated available evidence comparing mirabegron and solifenacin in pediatric OAB. METHODS: Following PRISMA guidelines (PROSPERO: CRD420251129236), we searched PubMed, Scopus, Web of Science, and the Cochrane Library through September 2025 for studies directly comparing mirabegron and solifenacin in children ≤ 18 years with non-neurogenic OAB. Two reviewers independently screened studies, extracted data, and assessed quality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. RESULTS: Three studies (246 children; 116 mirabegron, 130 solifenacin) met inclusion criteria. Pooled analysis showed no significant difference in treatment response between groups (RR = 1.11, 95% CI: 0.92–1.33; = 0.28; I² = 58%). Mirabegron was associated with significantly fewer adverse events (RR = 0.44, 95% CI: 0.28–0.70; = 0.0004; I² = 0%). CONCLUSIONS: Mirabegron and solifenacin demonstrate comparable efficacy in pediatric OAB, with mirabegron suggesting a more favorable short-term safety profile. These preliminary findings require confirmation in larger, long-term trials with standardized outcome measures. CLINICAL TRIAL REGISTRATION: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12894-026-02155-9.
Additional predictive value of systemic inflammation indices beyond prostate specific antigen density for clinically significant prostate cancer.
Sulhan H, Kalyenci B
BMC Urol · 2026 Apr · PMID 42001036 · Full text
BACKGROUND: This study aimed to investigate whether systemic inflammation indices provide additional predictive value beyond conventional clinical parameters, particularly prostate-specific antigen (PSA) and prostate-spe...
BACKGROUND: This study aimed to investigate whether systemic inflammation indices provide additional predictive value beyond conventional clinical parameters, particularly prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD), for the detection of clinically significant prostate cancer (csPCa) prior to transrectal ultrasound (TRUS)-guided prostate biopsy. METHODS: This retrospective, single-center study included patients who underwent TRUS-guided prostate biopsy due to elevated PSA levels and/or suspicious digital rectal examination findings. Data from 527 patients who underwent prostate biopsy were analyzed. Demographic data, serum PSA levels, prostate volume, PSAD, and prebiopsy complete blood count parameters were recorded. Systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and pan-immune inflammation value (PIV) were calculated. Patients were classified into three groups: benign prostate pathology, clinically insignificant prostate cancer (ciPCa), and csPCa, based on histopathological findings. Receiver operating characteristic (ROC) curve analyses and multinomial logistic regression models adjusted for age and PSAD were performed to assess predictive performance. RESULTS: Significant differences were observed among the benign, ciPCa and csPCa groups in terms of age, total PSA, prostate volume, and PSAD (all p < 0.001), with csPCa patients being older and exhibiting higher PSA and PSAD values. Among the inflammatory indices, only MLR differed significantly, being higher in the csPCa group compared to the ciPCa group (p = 0.028). ROC analysis identified MLR as a weak but statistically significant predictor of csPCa (AUC = 0.566, p = 0.011). In age- and PSAD adjusted regression analyses, PLR and SII were inversely associated with ciPCa, while age and PSAD ≥ 0.15 remained independent predictors of csPCa. Additionally, each 100-unit increase in PIV significantly reduced the likelihood of ciPCa (OR = 0.886, p = 0.026). CONCLUSION: Systemic inflammatory indices do not provide sufficient predictive power to replace established clinical parameters in pre-biopsy decision-making. PSA, PSAD and age remain the most reliable predictors of csPCa, while selected inflammatory markers may offer limited complementary information for risk stratification.
Body composition and renal cell carcinoma prognosis in elderly patients: a retrospective cohort study.
Pajunen H, Veitonmäki T, Åkerla J … +6 more , Aittoniemi A, Ronkainen J, Huhtala H, Nikkola J, Murtola TJ, Rinta-Kiikka I
BMC Urol · 2026 Apr · PMID 41998692 · Full text
BACKGROUND: Body composition has been proposed as a prognostic factor in renal cell carcinoma (RCC), but evidence remains inconsistent, particularly in elderly patients. This study aimed to evaluate whether computed tomo...
BACKGROUND: Body composition has been proposed as a prognostic factor in renal cell carcinoma (RCC), but evidence remains inconsistent, particularly in elderly patients. This study aimed to evaluate whether computed tomography (CT)-derived body composition indices are associated with overall survival (OS) in patients aged ≥ 75 years with RCC. METHODS: This retrospective cohort study included all RCC patients aged ≥ 75 years diagnosed at Tampere University Hospital between 2003 and 2017 with available abdominal CT imaging.The study cohort comprised 239 patients. The formation of the dataset is illustrated in Figure 1. Body composition parameters, including psoas muscle index (PMI), skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and waist circumference, were measured at the third lumbar vertebra level. The primary outcome was OS, and the secondary outcome was risk of surgical complications. Cox proportional hazards models were used for survival analyses, with adjustment for established prognostic factors. Subgroup analyses were performed, and associations with surgical outcomes were assessed using correlation and logistic regression analyses. RESULTS: A total of 239 patients aged ≥ 75 years with RCC were included. Median age at diagnosis was 80 years (75–94), and 67% underwent surgical treatment. Median follow-up was 4 (0-21) years. Sarcopenia was common across the cohort as low muscle mass was found in 95–100% of women and 94–98% of men. In univariable analysis, waist circumference showed a weak inverse association with OS (HR 0.99, 95% confidence interval (CI): 0.98–1.00). In subgroup analysis higher VATI was associated with improved survival among non-operated subgroup (HR 0.43, 95% CI 0.19–0.93). However, these findings were inconsistent and of small magnitude. No significant associations were observed in sex-stratified analyses. For surgical outcomes, weak correlations were found between waist circumference and VATI with intraoperative blood loss (r = 0.24, p = 0.024), SATI with length of hospital stay (r = 0.22, p = 0.013), and VATI with intraoperative organ injury (OR 1.01, 95% CI 1.00–1.02). After correction for multiple testing, only the association between VATI and blood loss remained significant. Overall, effect sizes were small. CONCLUSION: CT-derived body composition indices do not appear to have clinically meaningful utility in predicting OS or surgical complications in elderly RCC patients. These findings suggest that body composition measurements derived from routine CT imaging should not be used in isolation for risk stratification in this population. Instead, treatment decisions for elderly RCC patients should be based on a comprehensive geriatric assessment.
Association between volume per injection and treatment failure after water vapor thermal therapy.
Okabe T
BMC Urol · 2026 Apr · PMID 41998579 · Full text
BACKGROUND: Water vapor thermal therapy (WVTT) determines the injection strategy primarily according to prostatic urethral length. However, no quantitative indicator integrates prostate size and injection number. This st...
BACKGROUND: Water vapor thermal therapy (WVTT) determines the injection strategy primarily according to prostatic urethral length. However, no quantitative indicator integrates prostate size and injection number. This study evaluated the association between volume per injection (VPI), defined as prostate volume divided by the number of injections, and treatment failure after WVTT. METHODS: This retrospective study included 105 consecutive patients who received WVTT. Treatment failure represented the first occurrence of medication resumption, re-catheterization, or re-surgery. The Cox proportional hazards models were used to assess the association between continuous VPI and treatment failure. A multivariable model including the use of 5-alpha reductase inhibitor (5-ARI) was utilized in the sensitivity analysis. RESULTS: During a median follow-up of 455 (95% confidence interval [CI]: 377–538) days, 15 patients experienced treatment failure. A higher VPI was associated with an increased risk of treatment failure in the univariate analysis (hazard ratio per 1-mL increase: 1.21, 95% CI: 1.03–1.42, p = 0.020). The association remained significant after adjusting for the use of 5-ARI (hazard ratio: 1.23, 95% CI: 1.04–1.45, p = 0.018). CONCLUSIONS: A higher VPI was associated with an increased risk of treatment failure after WVTT for BPH. These findings suggest a potential relationship between injection density relative to prostate size and treatment durability. However, given the exploratory nature of the study and the limited number of events, the results should be interpreted with caution. Further prospective validation is warranted.
Association between varicocele and hemorrhoidal disease in men presenting with groin pain: a retrospective comparative study.
Yeni S, Kilciler M
BMC Urol · 2026 Apr · PMID 41987108 · Full text
OBJECTIVE: To evaluate the independent association between varicocele and hemorrhoidal disease in men presenting with groin pain. This study considers varicocele not merely as a localized scrotal condition, but as a pote...
OBJECTIVE: To evaluate the independent association between varicocele and hemorrhoidal disease in men presenting with groin pain. This study considers varicocele not merely as a localized scrotal condition, but as a potential manifestation of systemic venous insufficiency, sharing common pathophysiological mechanisms with hemorrhoidal disease, such as venous dilation and elevated pressure. MATERIALS AND METHODS: Between January 2023 and September 2025, 292 men presenting with groin pain were assessed, and 186 met the inclusion criteria. Group 1 consisted of 81 men with varicocele who underwent varicocelectomy, and Group 2 included 105 men without varicocele (controls). Beyond univariate comparisons, a multivariable logistic regression model was utilized to identify independent predictors and adjust for potential confounders, including constipation. Model stability and calibration were verified using the Hosmer-Lemeshow test and Variance Inflation Factor (VIF) analysis. RESULTS: There were no significant differences between groups regarding age, height, weight, body mass index, or smoking status (p > 0.05). Hemorrhoidal disease was significantly more frequent in the varicocele group than in controls (43.2% vs. 18.0%, p = 0.016). Multivariable logistic regression revealed that hemorrhoidal disease is a strong independent predictor of varicocele presence (Adjusted OR: 3.27; 95% CI: 1.66–6.59; p < 0.001). Additionally, constipation was identified as a significant independent predictor (Adjusted OR: 8.39; 95% CI: 2.61–37.64; p = 0.001). The model demonstrated high reliability with no multicollinearity (VIF = 1.00) and an acceptable goodness-of-fit (p = 0.054). CONCLUSION: Hemorrhoidal disease and constipation are independently associated with varicocele, consistent with a potential link through systemic venous insufficiency. Recognizing this association may facilitate a more comprehensive clinical evaluation of patients presenting with these interconnected venous conditions.
Anatomical approach in magnetic resonance imaging and ultrasonography fusion biopsy for prostate cancer detection: a cross-sectional study.
Chikazawa I, Kunii K, Kondou T … +1 more , Miyazawa K
BMC Urol · 2026 Apr · PMID 41975415 · Full text
BACKGROUND: Comparisons between the transperineal (TP) and the transrectal (TR) approach for prostate biopsies in detecting cancer have been reported; however, there are no reports comparing the cancer detection rates us...
BACKGROUND: Comparisons between the transperineal (TP) and the transrectal (TR) approach for prostate biopsies in detecting cancer have been reported; however, there are no reports comparing the cancer detection rates using an anatomical approach. In this study, magnetic resonance imaging and ultrasonography (MRI/US) fusion prostate biopsies were compared between the TP and the TR approaches for detecting cancer at the target sites. METHODS: The MRI/US fusion prostate biopsies were performed between November 2016 and October 2021. There were 251 and 200 patients in the TP and TR groups, respectively. Age, serum prostate specific antigen level, prostate volume, number of biopsies, target site (anterior, posterior, apex, lateral, base, middle), cancer detection rate, and the Gleason Grading Group classification were examined. RESULTS: There were 154 and 101 target sites in the TP and TR groups for Prostate Imaging Reporting and Data System (PI-RADS) category 4–5. Significantly higher cancer detection rates were noted for PI-RADS category 4–5 lesions than for category 3 lesions in both the TP and TR groups (p < 0.001). The cancer detection rates for category 4–5 lesions in the TP and TR groups were 94.4% and 73.3% (p = 0.036), 92.3% and 64.7% (p = 0.017), 69.4% and 93.3% (p = 0.055), and 66.7% and 89.3% (p = 0.010) at the anterior, apex, lateral, and posterior sites, respectively. CONCLUSIONS: The cancer detection rate was significantly different between the TP and TR groups at the anterior, apex, and posterior sites. These differences may be due to the sampling deflection of the needle on the posterior site in the TP group and on the apex and anterior sites in the TR group. These results suggest that urologists should be mindful of the benefits for each patient by considering the advantages with each approach.
Successful complex penile prosthesis implant in patients with high risk of fecal contamination: a two case report.
Malhotra V, Sah AK, Aravind TK
BMC Urol · 2026 Apr · PMID 41975381 · Full text
BACKGROUND: Penile prosthesis implantation in patients at risk of fecal contamination presents a significant infection risk and is rarely reported. CASE PRESENTATION: We report two male patients (aged 26 and 42 years) wi...
BACKGROUND: Penile prosthesis implantation in patients at risk of fecal contamination presents a significant infection risk and is rarely reported. CASE PRESENTATION: We report two male patients (aged 26 and 42 years) with refractory erectile dysfunction following multimodal treatment for carcinoma anorectum. One patient had a permanent colostomy after abdominoperineal resection, while the other developed persistent fecal incontinence following low anterior resection. Both failed conservative therapies and underwent malleable penile prosthesis implantation under strict aseptic precautions, including extended skin preparation, isolation of contaminated sites, double draping, and intraoperative antibiotic irrigation. Postoperative recovery was uneventful, with no evidence of infection at 3-month follow-up. CONCLUSION: Penile prosthesis implantation can be safely performed in selected high-risk patients with fecal contamination risk when meticulous perioperative infection control strategies are implemented.
Stone composition in patients undergoing surgical treatment for kidney stones: a cross-sectional study at a tertiary hospital in Vietnam.
Nguyen XC, Do AT, Ho HL … +1 more , Nguyen VH
BMC Urol · 2026 Apr · PMID 41975351 · Full text
OBJECTIVE: Evaluate the composition of kidney stones in patients undergoing surgical interventions at Binh Dan Hospital. SUBJECTS AND METHODS: Patients undergoing surgical management for renal or ureteral calculi at Binh...
OBJECTIVE: Evaluate the composition of kidney stones in patients undergoing surgical interventions at Binh Dan Hospital. SUBJECTS AND METHODS: Patients undergoing surgical management for renal or ureteral calculi at Binh Dan Hospital between July 2023 and April 2025 were included. Stone composition was determined by infrared spectroscopy and X-ray diffraction. RESULTS: A total of 765 stone units from 743 patients were analyzed. Percutaneous nephrolithotomy accounted for most procedures (86.01%), followed by retroperitoneal laparoscopic ureterolithotomy (7.32%), semirigid ureterolithotripsy (5.10%), and open surgery (1.57%). The composition of the stones revealed that calcium oxalate stones were the most common at 63.4%, including whewellite (calcium oxalate monohydrate) at 51.9% and weddellite (calcium oxalate dihydrate) at 11.5%. Phosphate stones were the next most common, with dahllite (hydroxyapatite) accounting for 25.49% and brushite accounting for 0.52%. Among infection stones, truvite accounted for 3.4% and ammonium hydrogen urate accounted for 0.26%. Uric acid stones and the rare cystine stones accounted for 5.88% and 1.05%, respectively. The proportion of mixed stones in this study accounted for 58.56%. The combinations containing whewellite predominated, accounting for 86.13%. The combination of whewellite + weddellite + dahllite was the most prevalent, representing 31.76% of the cases. CONCLUSION: Calcium oxalate was the most common stone type. Compared with global data, variations were observed only in selected stone components, suggesting possible regional influences.
Comprehensive comparison of Bioprotect balloon and Barrigel hydrogel rectal spacers in proton therapy for prostate cancer.
Arnold J
BMC Urol · 2026 Apr · PMID 41963881 · Full text
BACKGROUND: To compare the geometric consistency, dosimetric performance, and early clinical outcomes of the BioProtect balloon spacer versus the Barrigel hydrogel spacer in patients receiving proton therapy for prostate...
BACKGROUND: To compare the geometric consistency, dosimetric performance, and early clinical outcomes of the BioProtect balloon spacer versus the Barrigel hydrogel spacer in patients receiving proton therapy for prostate cancer. METHODS: This retrospective study analyzed 50 prostate cancer patients treated with proton therapy: 25 with BioProtect and 25 with Barrigel. Anatomical displacement, rectal dose (V70/V60/V50), rectal wall infiltration (RWI), and early gastrointestinal (GI) toxicity were assessed. Two treatment plans per patient (prostate-only and whole-pelvis) were generated using identical optimization workflows. Geometric and dosimetric comparisons were performed using t-tests, and correlations between anatomy and dose were evaluated. RESULTS: BioProtect achieved greater midgland (18.28 mm vs. 14.52 mm, p < 0.01) and apical (12.8 mm vs. 8.3 mm, p < 0.001) separation. Prostate-only plans with BioProtect showed significantly lower rectal V60 (2.02% vs. 6.69%) and V50 (4.28% vs. 10.16%) (p < 0.01). Whole-pelvis plans showed V70/V60/V50 reductions of 72.8%, 66.1%, and 66.7%, respectively (all p < 0.01). No RWI events occurred in the BioProtect arm, compared to three with Barrigel. Acute grade ≥ 2 GI toxicity was observed in 0% of BioProtect vs. 17.4% of Barrigel patients at 3 months. CONCLUSION: BioProtect demonstrated superior and more consistent rectal sparing in proton therapy compared to Barrigel. The fixed geometry balloon design yielded enhanced separation, reduced rectal dose, and fewer early GI toxicities. These findings suggest an dosimetric and clinical advantage of BioProtect in the proton therapy setting.
Machine learning to predict ureteral access sheath placement failure in flexible ureteroscopy: development and prospective validation.
Li L, Yang S, Jiang Z … +4 more , Feng R, Wang G, Zha B, Gao F
BMC Urol · 2026 Apr · PMID 41943099 · Full text
BACKGROUND: Failed placement of a Ureteral Access Sheath (UAS) during flexible ureteroscopic lithotripsy (FURL) creates significant operative challenges. The objective of this study was to develop a machine learning (ML)...
BACKGROUND: Failed placement of a Ureteral Access Sheath (UAS) during flexible ureteroscopic lithotripsy (FURL) creates significant operative challenges. The objective of this study was to develop a machine learning (ML) model that integrates diverse indicators to predict the likelihood of UAS placement failure. METHODS: We conducted an analysis of clinical records from 1,153 patients diagnosed with upper urinary tract calculi, followed by the enrollment of 265 consecutive patients for independent prospective validation. The predictive model integrated variables including patient medical history, parameters from CT imaging, anesthesia modality, and markers of systemic inflammation. Nine distinct ML algorithms were formulated. The predictive performance of the model was subsequently compared with that of senior urologists in a prospective setting. RESULTS: The final dataset comprised retrospective (n = 651) and prospective (n = 265) cohorts, both exhibiting similar failure rates of approximately 30%. Among the tested algorithms, the RF model yielded superior performance, attaining an area under the curve (AUC) of 0.845 in the testing set. During prospective validation, the simplified RF model achieved an AUC of 0.872, significantly surpassing the predictive accuracy of senior urologists. Through SHAP analysis, the mid-ureteral diameter, distal ureteral diameter, neutrophil count, renal parenchyma width, and the long diameter of the calculus were identified as the five most critical predictors. Furthermore, the model exhibited robust stability across various subgroups. CONCLUSIONS: We successfully developed and prospectively validated a robust ML model capable of predicting UAS placement failure. By assimilating clinical, imaging, and inflammatory data, this model demonstrated superior performance compared to clinical experts. It provides a dependable instrument for personalized preoperative risk stratification and surgical strategy planning, accessible via a newly deployed web application.
Structured template for standardised reporting of non-contrast computed tomography in urinary stone disease as a superior tool for urologists - a randomised controlled trial.
Glienke M, von Bargen M, Wilhelm K … +7 more , Miernik A, Kotter E, Neubauer J, Weiß J, Arnold P, Gratzke C, Schoenthaler M
BMC Urol · 2026 Apr · PMID 41943025 · Full text
BACKGROUND: Standardised structured reporting (SR) aims to improve the clarity, completeness, and clinical applicability of radiological reports. For non-contrast computed tomography (NCCT) of urinary stones, a reporting...
BACKGROUND: Standardised structured reporting (SR) aims to improve the clarity, completeness, and clinical applicability of radiological reports. For non-contrast computed tomography (NCCT) of urinary stones, a reporting template was developed collaboratively by the German Radiologic Society and the German Society of Urology. This study evaluates urologists’ satisfaction with SR compared to free-text reports (NR). METHODS: A randomised controlled trial was conducted with 200 NCCT reports (100 SR, 100 NR). Five urologists of varying experience levels assessed the reports using a questionnaire, covering content, formal aspects, clinical consequences, and overall report quality. Scores were based on a 6-point Likert scale (0–6). RESULTS: Structured reports significantly outperformed free-text reports in all evaluated domains (p < 0.001). SR provided clearer descriptions of stone characteristics and radiographic signs, enabling precise clinical decision-making. The overall satisfaction score for SR was 5.83 ± 0.56 compared to 4.18 ± 1.13 for NR. Formal aspects, such as report structure, also showed marked improvements in SR. CONCLUSION: The findings demonstrate SR’s superiority in clinical utility, completeness, and clarity. By facilitating Artificial Intelligence integration and secondary data analysis, SR offers additional advantages. Broader adoption requires promoting user acceptance and validating translated versions for international use.
Is ambulatory flexible ureteroscopic lithotripsy safe and feasible? evidence from a propensity score-matched cohort.
Tian C, Gu J, Wang L … +6 more , Xiong L, Yang B, Hu H, Xu T, Xu J, Liu J
BMC Urol · 2026 Apr · PMID 41937188 · Full text
OBJECTIVE: To evaluate the safety, efficacy, and health economic value of flexible ureteroscopic lithotripsy (fURS) for upper urinary tract stones in ambulatory surgery compared to traditional inpatient management. METHO...
OBJECTIVE: To evaluate the safety, efficacy, and health economic value of flexible ureteroscopic lithotripsy (fURS) for upper urinary tract stones in ambulatory surgery compared to traditional inpatient management. METHODS: A retrospective cohort study analyzed 174 fURS cases performed by a single surgeon between January and December 2024. Patients were divided into ambulatory and inpatient groups. Propensity score matching (PSM, 1:1 ratio) was applied to balance baseline differences. Demographic data, perioperative parameters, and outcomes including stone-free rate (SFR, assessment via abdominal X-ray within 24 h postoperatively, with residual fragments > 2 mm considered significant), complication rates (Clavien-Dindo classification), hospitalization duration, and costs were analyzed. RESULTS: A total of 174 patients with upper urinary tract stones were included. Pre-matching analysis revealed that the inpatient group had significantly older age (58.55 ± 12.52 vs. 50.14 ± 12.79 years, P < 0.001), larger cumulative stone diameter (1.67 ± 0.74 vs. 1.34 ± 0.57 cm, P = 0.001), and longer operative time (53.09 ± 26.64 vs. 41.30 ± 21.45 min, P = 0.002). No significant differences were observed in postoperative complications (2.33% vs. 1.14%, P = 0.491) or SFR (80.23% vs. 82.95%, P = 0.789). The ambulatory group demonstrated a 74.6% reduction in hospitalization duration (1.09 ± 0.29 vs. 4.29 ± 1.14 days, P < 0.001) and lower unadjusted total costs (27,075.41 ± 4,112.93 vs. 29,240.94 ± 3,856.12 RMB, P < 0.001). Post-PSM analysis confirmed comparable baseline characteristics, with the ambulatory group maintaining shorter hospitalization (1.12 ± 0.33 vs. 4.18 ± 1.09 days, P < 0.001), with no statistically significant difference in total costs between the two groups (27,378.33 ± 3768.93 vs. 28,639.67 ± 4,033.38 RMB, P = 0.106). CONCLUSION: Ambulatory fURS represents a safe and effective treatment option for selected patients with upper urinary tract stones. This model substantially reduces hospitalization duration without compromising surgical outcomes or patient safety in carefully selected patients treated by experienced surgeons.
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