BMC Urology[JOURNAL]
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200 papers
Comparatıve evaluatıon of the brıgantı nomogram, partın nomogram, mskcc nomogram and a machıne learnıng-based model ın predıctıng lymph node ınvasıon before radıcal prostatectomy.
Yılmaz IO, Yılmaz O, Zubaroglu M … +5 more , Kavak R, Akdogan N, Arikan MG, Deger M, Izol V
BMC Urol · 2026 Apr · PMID 41923245 · Full text
INTRODUCTION: Accurate preoperative prediction of lymph node invasion (LNI) is crucial for deciding on extended pelvic lymph node dissection (ePLND) in radical prostatectomy. Traditional nomograms such as Briganti, Parti...
INTRODUCTION: Accurate preoperative prediction of lymph node invasion (LNI) is crucial for deciding on extended pelvic lymph node dissection (ePLND) in radical prostatectomy. Traditional nomograms such as Briganti, Partin, and MSKCC are widely used, but machine learning (ML)–based models may improve predictive accuracy. MATERIALS AND METHODS: Data from 471 prostate cancer patients were analyzed, including demographic, clinical, and histopathological variables and scores from Briganti, Partin, and MSKCC nomograms. Eleven ML algorithms were evaluated, with performance assessed by AUC-ROC, accuracy, sensitivity, specificity, and F1-score. Class imbalance was addressed with resampling techniques, and feature importance analyses were performed. RESULTS: LNI was present in 97 patients (20.6%). Significant predictors included MSKCC and Partin scores, PSA, ISUP grade, PIRADS score, lymphovascular invasion, and age. Neural Network (AUC: 0.81) and Random Forest (AUC: 0.77) showed similar performance to the nomograms (MSKCC: 0.79; Briganti: 0.77; Partin: 0.78) when considering the AUC values and their 95% confidence intervals.Decision tree analysis highlighted negative core count, ISUP grade, prostate density, PSA, BMI, and age as key variables. Combining nomogram scores with ML models resulted in numerically slightly higher AUC values; however, these differences remained within a similar performance range and did not indicate a clinically meaningful improvement. CONCLUSION: Although the AUC values of the ML models appear numerically comparable to, or slightly higher than, those of traditional nomograms, the inherent limitations of the study preclude demonstrating a clinically superior or reliably advantageous performance; therefore, multicenter prospective validation studies are warranted.
Zinner syndrome associated with concealed penis and azoospermia in an adolescent: a case report and literature review.
Wang Y, Lv Z, Zhang C … +6 more , Xu Y, Zhao Y, Wang X, Chen W, Jin Y, Jia Z
BMC Urol · 2026 Apr · PMID 41923047 · Full text
BACKGROUND: Zinner syndrome is a rare congenital malformation of the male urogenital system, characterized by ipsilateral renal agenesis, ejaculatory duct obstruction, and seminal vesicle cysts. Owing to its nonspecific...
BACKGROUND: Zinner syndrome is a rare congenital malformation of the male urogenital system, characterized by ipsilateral renal agenesis, ejaculatory duct obstruction, and seminal vesicle cysts. Owing to its nonspecific clinical presentation, the condition is frequently underrecognized or misdiagnosed. CASE PRESENTATION: A 17-year-old male presented with a 1-month history of dysuria. Imaging studies revealed right renal agenesis and a giant posterior pelvic cyst causing compression of the urinary bladder. Semen analysis demonstrated azoospermia, while spermatozoa were successfully retrieved by percutaneous epididymal sperm aspiration, supporting a diagnosis of obstructive azoospermia. Physical examination revealed a concealed penis. Based on combined clinical, laboratory, and radiological findings, a diagnosis of Zinner syndrome was established. The patient underwent robot-assisted laparoscopic excision of the pelvic cyst. Postoperatively, urinary symptoms improved markedly, and no complications or recurrence were observed during short-term follow-up. CONCLUSION: Although Zinner syndrome is exceedingly rare, it should be considered in the differential diagnosis of pelvic cystic masses in young male patients, particularly when accompanied by ipsilateral renal agenesis, lower urinary tract symptoms, or fertility-related abnormalities. Early recognition and appropriate imaging evaluation may facilitate timely surgical intervention, symptom relief, and individualized counseling regarding reproductive potential.
Efficacy of thulium fiber laser litothripsy on large renal stones (> 1000 mm³) according to Hounsfield units: a prospective single-center study.
Baturu M, Seckiner I, Bayrak O … +3 more , Kirac M, Ozturk M, Erturhan S
BMC Urol · 2026 Apr · PMID 41923045 · Full text
BACKGROUND: This study evaluated the efficacy and safety of Thulium Fiber Laser (TFL) lithotripsy based on stone density and factors affecting success in retrograde intrarenal surgery (RIRS) for renal calculi > 1000 mm3....
BACKGROUND: This study evaluated the efficacy and safety of Thulium Fiber Laser (TFL) lithotripsy based on stone density and factors affecting success in retrograde intrarenal surgery (RIRS) for renal calculi > 1000 mm3. METHODS: Eighty-one patients who underwent RIRS with TFL for renal calculi > 1000 mm3 were evaluated prospectively and categorized into two groups based on stone density [Group 1:<1000 Hounsfield Units (HU); Group 2:≥1000 HU]. Demographic data, stone-free rates (SFRs), need for second RIRS, and complications were also recorded. Laser parameters, including lasing time, energy usage, ablation speed, efficiency, and energy consumption, were calculated. RESULTS: Mean HU values differed significantly between groups (731.65 ± 220.54 vs. 1207.92 ± 147.75,p = 0.001). Laser energy consumption was lower in group 2 (14.83 ± 10.15 vs. 18.01 ± 16.02 J/mm3,p = 0.045).No significant differences were observed in the other laser parameters (ablation efficiency, ablation speed, total energy used). Need for second RIRS rates were similar (26.83% vs. 30.00%,p = 0.752). SFRs after first and second RIRS were comparable between the groups (53.66% vs. 40.00%,p = 0.218; 70.73% vs. 57.50%,p = 0.214).Laser ablation efficiency (p = 0.004), ablation speed (p = 0.036), and operative time (p < 0.001) positively correlated with SFR in univariate analysis, but not in multivariate analysis.Stone location, and preoperative double J stent presence did not affect SFRs. The complication rate was 12.35%, with most complications being mild (Clavien I and II). CONCLUSION: TFL is effective and safe for treating large kidney stones using RIRS. Stone density did not significantly affect the outcomes, suggesting TFL’s versatility across different stone compositions. TFL lithotripsy is a promising option for the treatment of large renal calculi. TRIAL REGISTRATION: NCT07153978.
Testis-sparing surgery for Leydig cell tumor in children: long-term results of a multicentric retrospective cohort study.
Wei J, Li Z, Du G … +4 more , Yang C, Li N, Yang M, Tang D
BMC Urol · 2026 Mar · PMID 41917881 · Full text
BACKGROUND: Leydig cell tumors (LCTs) of the testis are rare in children. Although testis-sparing surgery (TSS) is increasingly accepted as the preferred treatment, large-scale studies with long-term follow-up remain lim...
BACKGROUND: Leydig cell tumors (LCTs) of the testis are rare in children. Although testis-sparing surgery (TSS) is increasingly accepted as the preferred treatment, large-scale studies with long-term follow-up remain limited. This study compared the clinical characteristics of LCTs with those of testicular teratomas and endodermal sinus tumors and evaluated the long-term outcomes of TSS in children to enhance urologists’ understanding of this condition. METHODS: Patients diagnosed with LCTs between January 2015 and December 2024 at three tertiary medical centers were enrolled, along with equal numbers of patients with testicular endodermal sinus tumors and testicular teratomas as control groups. Clinical data were collected and analyzed using SPSS 22.0 software. RESULTS: This study enrolled 14 patients with testicular LCTs, 14 with testicular endodermal sinus tumors, and 14 with testicular teratomas. Patients with LCTs exhibited a significantly older age at presentation (P = 0.003). Precocious puberty was more prevalent in LCT patients (P < 0.001), and elevated serum testosterone levels were identified in 9 of 14 patients (64.3%). Scrotal ultrasound revealed hypoechoic masses with peripheral rim hypervascularization in LCT-affected testes, features absent in the other two groups (P < 0.001). All LCT patients underwent TSS with microscopically negative margins, and no patient experienced recurrence during follow-up (median: 42 months; range: 15–61 months). Furthermore, affected testes reached volumes comparable to those of the contralateral healthy testis within 3–4 years postoperatively. CONCLUSION: This study compares pediatric LCTs with testicular teratomas and endodermal sinus tumors to help urologists diagnose LCTs earlier and reduce misdiagnosis. The findings support TTS as an effective treatment for pediatric LCTs that preserves testicular function. Long-term follow-up using scrotal sonography and endocrine evaluation is supportive for managing pediatric LCTs.
Association between novel indicators for inflammation and metabolism and kidney stones: a cross-sectional analysis of NHANES 2007-2018.
Wang J, Wang Y, Zhou X … +7 more , Wang J, Xu S, Liu Z, Xia Y, Wang Y, Fan Y, Jiao W
BMC Urol · 2026 Mar · PMID 41896861 · Full text
BACKGROUND: This study aimed to investigate the association between kidney stones and novel indicators for inflammation and metabolism, including the neutrophil percentage-to-albumin ratio (NPAR), the neutrophil count-to...
BACKGROUND: This study aimed to investigate the association between kidney stones and novel indicators for inflammation and metabolism, including the neutrophil percentage-to-albumin ratio (NPAR), the neutrophil count-to-albumin ratio (NAR), the uric acid-to-high-density lipoprotein cholesterol ratio (UHR), and the lymphocyte count-to-high-density lipoprotein cholesterol ratio (LHR). METHODS: The study analyzed 59,842 participants from the National Health and Nutrition Examination Survey spanning from 2007 to 2018, with 27,420 remaining after exclusions. The determination of kidney stones was determined by the personal history of kidney stones reported through the questionnaire. All indicators were calculated based on the relevant data extracted from the database. Weighted logistic regression and restricted cubic spline (RCS) analyses were performed to evaluate the association between indicators and kidney stones. Furthermore, subgroup analyses and interaction tests were conducted to assess the robustness and generalizability of the results. RESULTS: In this study, 2,636 of the enrolled participants were identified as having kidney stones. Following adjustment for all covariates, multivariate logistic regression analysis demonstrated a significant positive relationship between kidney stones and NPAR (OR: 1.63, 95% CI: 1.22-2.18, p = 0.001), NAR (OR: 1.20, 95% CI: 1.04-1.40, p = 0.015), UHR (OR: 1.43, 95% CI: 1.15-1.79, p = 0.002), and LHR (OR: 1.15, 95% CI: 1.02-1.30, p = 0.026). However, the significant association of NAR was no longer observed in quartile analysis and trend analysis. RCS analysis demonstrated a nonlinear association between NAR, UHR, LHR, and kidney stones. Furthermore, sex was the key factor in subgroup analysis of NPAR and LHR, whereas age was the key factor for UHR and NAR. CONCLUSION: This study found that higher NPAR, NAR, UHR, and LHR levels were linked to increased kidney stone risk. UHR exhibits greater stability in comparison to other indicators. Subgroup analyses emphasized the need to consider demographic factors when interpreting these indicators. Further prospective studies are essential to confirm the results.
Integrating vaginal laser therapy into multidisciplinary management of bladder pain syndrome and vulvodynia.
Okui N
BMC Urol · 2026 Mar · PMID 41896860 · Full text
BACKGROUND: Bladder pain syndrome/interstitial cystitis (BPS/IC) and vulvodynia frequently co-occur, forming overlapping pelvic pain syndromes that often evade organ-centered management. Shared mechanisms—urothelial/epit...
BACKGROUND: Bladder pain syndrome/interstitial cystitis (BPS/IC) and vulvodynia frequently co-occur, forming overlapping pelvic pain syndromes that often evade organ-centered management. Shared mechanisms—urothelial/epithelial dysfunction, neuroinflammation, and pelvic floor hypertonicity—support multidisciplinary, mechanism-based care. Because high-quality clinical evidence specifically targeting the BPS/IC + vulvodynia overlap remains limited, this narrative review also evaluates laser-based therapies in clinically adjacent conditions with shared anatomy and pathophysiology (e.g., genitourinary syndrome of menopause and vulvar dermatoses) to contextualize plausibility and inform future study design. MAIN BODY: Non-ablative erbium-doped yttrium aluminum garnet (Er:YAG) and neodymium-doped yttrium aluminum garnet (Nd:YAG) vaginal/vulvar protocols have shown encouraging improvements in superficial vulvar pain, dyspareunia, sexual function, and—in selecte cohorts—bladder-related symptoms among patients with coexisting BPS/IC and vulvodynia. Transvaginal photobiomodulation (TV-PBM) is emerging as another non-ablative modality with putative mitochondrial, anti-inflammatory, and neuromodulatory effects. Across modalities, histological and imaging reports describe epithelial thickening, glycogen restoration, neovascularization, and collagen remodeling, consistent with tissue repair within the urogynecologic–pelvic floor unit. Proposed mechanisms include sublethal photothermal activation of heat-shock responses, modulation of microvascular tone, and attenuation of inflammatory mediators. Nevertheless, current evidence is dominated by small case series and non-controlled studies with heterogeneous parameters and short follow-up; long-term efficacy, safety, dose, targets, and schedules remain to be standardized. Recent clustering and phenotyping work highlights BPS/IC subtypes—including vulvodynia-predominant groups with distinct psychological and quality-of-life profiles—suggesting that responses to laser modalities are likely phenotype-dependent. In parallel, natural-language analyses reveal “semantic drift” between clinical terms and patients’ everyday symptom language, indicating a role for AI-assisted processing of diaries and free-text to refine phenotyping and endpoint selection. CONCLUSIONS: Vaginal/vulvar laser therapy and TV-PBM can be positioned as mechanism-specific modules within individualized, multidisciplinary care for BPS/IC and vulvodynia. Priority next steps include adaptive or stratified randomized trials, harmonized energy/targeting protocols, multidimensional patient-reported outcomes, and rational combinations with pelvic floor rehabilitation, hormonal or androgen-sparing approaches, and psychological interventions. Incorporating AI-based profiling and vocabulary mapping into clinical workflows may sharpen subtype recognition and treatment targeting, ultimately improving outcomes for patients with overlapping BPS/IC and vulvodynia.
Added value of systematic biopsy in patients with positive MRI-US fusion targeted biopsy for clinically significant prostate cancer: a single-center retrospective study.
Zhang J, Chen J, Jin J … +2 more , Chen J, Zheng B
BMC Urol · 2026 Mar · PMID 41896841 · Full text
PURPOSE: To evaluate the added value of systematic biopsy (SB) in patients with positive targeted biopsy (TB) in the context of transperineal MRI-US fusion prostate biopsy, specifically focusing on clinically significant...
PURPOSE: To evaluate the added value of systematic biopsy (SB) in patients with positive targeted biopsy (TB) in the context of transperineal MRI-US fusion prostate biopsy, specifically focusing on clinically significant prostate cancer (csPCa), and to identify characteristics of patients who may benefit from a TB-only strategy. METHODS: We retrospectively enrolled 260 patients who underwent transperineal MRI-US fusion biopsy (4-core TB plus 12-core SB) at Nantong First People’s Hospital between May 2024 and November 2025. All patients had positive TB results for prostate cancer. SB zero-benefit for csPCa was defined as TB detecting csPCa (Grade Group ≥ 2) while SB detecting no csPCa (either negative or only Grade Group 1). Multivariate logistic regression was used to analyze predictors of SB zero-benefit. A predictive model was constructed and validated using Bootstrap (2000 resamples). Model performance was assessed using ROC curves, calibration plots, and decision curve analysis (DCA). RESULTS: Among 260 patients with TB-detected csPCa, 25 (9.6%) exhibited SB zero-benefit for csPCa. Compared with the SB-positive group (n = 235), the SB zero-benefit group exhibited significantly larger prostate volume, lower PSAD, smaller lesion size, and a distribution toward lower-risk PI-RADS scores. Multivariate analysis revealed that lesion size (OR = 0.802, 95%CI: 0.657–0.978, P = 0.030) and PI-RADS score (4 vs. 3: OR = 0.022, P < 0.001; 5 vs. 3: OR = 0.027, P = 0.013) were independent predictors of SB zero-benefit. The predictive model demonstrated excellent discrimination (AUC = 0.910, 95%CI: 0.851–0.968; bootstrap-corrected AUC = 0.892) with acceptable calibration (Hosmer-Lemeshow P = 0.503). At the optimal cutoff (predicted probability = 0.122), sensitivity of 84.0%, specificity of 87.2%, and negative predictive value (NPV) of 98.1%. If SB had been omitted, 25 patients (9.6%) with csPCa detected only by SB would have been missed, while TB alone detected 100% of csPCa in this cohort. DCA showed higher net benefit across threshold probabilities of 0.1–0.9 compared to the “biopsy-all” strategy. CONCLUSIONS: Approximately 10% of patients with TB-detected csPCa exhibited SB zero-benefit, characterized by small lesions (≤ 11 mm) and low PI-RADS scores (3–4). The predictive model based on lesion size and PI-RADS effectively identified patients with low SB value (NPV 98.1%) in this internal validation. However, given the single-center retrospective design, small event number (n = 25), lack of external validation, and the 9.6% miss rate if SB were omitted, this model requires prospective multicenter validation before clinical implementation. For patients at initial diagnosis, a transperineal TB-only strategy may warrant further prospective validation in selected patients with PI-RADS 3–4 lesions ≤ 11 mm, whereas PI-RADS 5 lesions should undergo combined biopsy given the risk of false-positive MRI findings and the need for maximal cancer characterization. CLINICAL TRIAL NUMBER: Not applicable.
A scoping review of risk factors for urinary tract infections following renal transplantation.
Kuang M, Chen J, Li Z
BMC Urol · 2026 Mar · PMID 41888750 · Full text
OBJECTIVE: This review aims to identify the risk factors associated with urinary tract infections(UTIs) after kidney transplantation, providing a reference for the early recognition and prevention of these infections in...
OBJECTIVE: This review aims to identify the risk factors associated with urinary tract infections(UTIs) after kidney transplantation, providing a reference for the early recognition and prevention of these infections in clinical practice. METHODS: The Joanna Briggs Institute methodology framework for scoping reviews was adopted as the methodological guidance, and literature searches were performed in PubMed, Web of Science, the Cochrane Library, Embase, and CINAHL, with the search period spanning from the inception of each database to October 15, 2025. Data extraction and summary analysis were carried out on the included literature. RESULTS: A total of 29 studies were included, and 28 risk factors for UTIs after kidney transplantation were identified, which were categorized into four groups: patient factors, disease-related factors, treatment-related factors, and other factors. CONCLUSIONS: Existing research indicates that factors influencing UTIs after kidney transplantation are multifaceted (including patient factors, disease-related factors, treatment-related factors, and other factors) and exhibit regional differences. It is necessary to control these influencing factors according to specific circumstances and to develop appropriate nursing measures.
Accidental transcutaneous displacement of a fiducial marker during transperineal prostate biopsy: a case report and narrative review.
Müssgens C, Roth B, Arnold N … +3 more , Schneidewind L, Shelan M, Giudici N
BMC Urol · 2026 Mar · PMID 41882598 · Full text
BACKGROUND: Fiducial markers are commonly used to guide precise radiotherapy in prostate cancer patients. While intraprostatic migration has been described, transcutaneous displacement during biopsy is exceedingly rare....
BACKGROUND: Fiducial markers are commonly used to guide precise radiotherapy in prostate cancer patients. While intraprostatic migration has been described, transcutaneous displacement during biopsy is exceedingly rare. We report the first known case of transcutaneous fiducial marker removal during transperineal prostate rebiopsy. CASE PRESENTATION: A 62-year-old man with high-risk prostate cancer underwent radiotherapy with gold fiducial markers in 2020. Following two biochemical recurrences, transperineal MRI/ultrasound fusion-guided biopsy was performed in 2024. Increased resistance was encountered during the final biopsy pass, and a gold marker was found embedded in the core sample and was inadvertently removed transcutaneously. The procedure was well tolerated, and no complications occurred. CONCLUSIONS: This case illustrates that even long after implantation, fiducial markers may still become dislodged during prostate interventions. While the event was asymptomatic, it highlights the importance of procedural awareness and planning to prevent potential compromise of radiotherapy accuracy in future cases.
A study on metabolic differences between infectious and non-infectious stones in patients with urine culture positive for Proteus mirabilis.
Zhang E, Chi Z, Zhang X … +3 more , Li J, Ji C, Hu W
BMC Urol · 2026 Mar · PMID 41872874 · Full text
OBJECTIVE: To compare the clinical characteristics of infectious and non-infectious stones in patients with urinary tract infections caused by Proteus mirabilis and to explore associated influencing factors. METHODS: Cli...
OBJECTIVE: To compare the clinical characteristics of infectious and non-infectious stones in patients with urinary tract infections caused by Proteus mirabilis and to explore associated influencing factors. METHODS: Clinical data from 93 patients with upper urinary tract stones and concomitant Proteus mirabilis urinary tract infection treated between 2015 and 2021 were retrospectively analyzed. Patients were classified according to postoperative stone composition. Demographic characteristics and preoperative laboratory parameters were compared between groups, and multivariate logistic regression analysis was performed to identify factors associated with infectious stones. RESULTS: Of the 93 patients included, 70 (75.3%) had infectious stones and 23 (24.7%) had non-infectious stones. Patients in the infectious stone group were younger and had a lower body mass index (BMI) than those in the non-infectious stone group (P < 0.05). The 24-h urine volume was significantly lower in the non-infectious stone group (P < 0.05). Multivariate analysis showed that older age, higher BMI, and lower urine volume were significantly negatively associated with the presence of infectious stones, whereas diabetes mellitus was significantly associated with infectious stones. CONCLUSION: Patients with non-infectious stones should be advised to increase fluid intake and manage body weight. In contrast, patients with infectious stones, particularly those with concomitant diabetes mellitus, require strict glycemic control and active anti-infective treatment to reduce the risk of stone formation.
Prostate-specific antigen clearance after surgery for benign prostate enlargement in a cohort with median prostate-specific antigen greater than 4ng/ml.
Nwosu EO, Mbadiwe OM, Nwosu NI … +4 more , Nnabugwu CA, Anakebe IN, Osaat IS, Nnabugwu II
BMC Urol · 2026 Mar · PMID 41872810 · Full text
BACKGROUND: Total prostate-specific antigen (tPSA) could be elevated in some cases of benign prostate enlargement (BPE). The aim of this study is to evaluate tPSA clearance after surgery for BPE with histologic confirmat...
BACKGROUND: Total prostate-specific antigen (tPSA) could be elevated in some cases of benign prostate enlargement (BPE). The aim of this study is to evaluate tPSA clearance after surgery for BPE with histologic confirmation of nodular hyperplasia. METHODS: Men for transurethral resection of the prostate (TURP), or open simple prostatectomy (OSP), with benign imaging features of the prostate were recruited. Those with tPSA >4ng/ml, but benign core-needle biopsy reports were recruited as well. A control arm of men on Tamsulosin+Dutasteride therapy (TDT) for BPE was also recruited. Participants with histologic finding of chronic prostatitis or malignancy at biopsy or post extirpation were excluded. Age, body mass index (BMI), prostate volume (PV) and presenting clinical features were noted. The tPSA values were taken at baseline, 6 weeks and 12 weeks post intervention. The mass of resected or enucleated prostate tissue was noted and the tPSA clearance curve was plotted. RESULTS: There were 154 participants: 77 were on TDT, 43 had monopolar TURP and 34 had OSP. The TDT patients were younger (61.57 ± 6.93years TDT vs. 65.4 ± 9.08years TURP vs. 63.71 ± 7.23years OSP; p 0.03), had lower median tPSA [5.6(4.0–7.6)ng/ml TDT vs. 10.0(5.7–13.1)ng/ml TURP vs. 15.8(9.0–20.0)ng/ml OSP; p < 0.001], and had lower PV (51.96 ± 5.22 ml TDT vs. 62.42 ± 7.16 ml TURP vs. 113.13 ± 29.57 ml OSP; p < 0.001) at recruitment. The 3 groups had similar BMI (26.25 ± 1.68 kg/m2 TDT vs. 25.72 ± 2.72 kg/m2 TURP vs. 26.05 ± 2.23 kg/m2 OSP; p 0.44). The tPSA clearance post-surgery correlated with the pre-surgery tPSA and was at a rate of y = 11.168e− 0.151x (y=tPSA; x=time). At 6 weeks post-surgery, 45.5% had tPSA < 4.0ng/ml, and at 12 weeks, 96.1% had tPSA < 4.0ng/ml. CONCLUSION: Where tPSA is ≥ 1.5ng/ml in BPE, surgery in form of TURP or OSP results in exponential decrease in serum tPSA.
Flexible and Navigable Suction Ureteral Access Sheath (FANS) versus conventional stone-pushing technique for impacted upper ureteral stones: a retrospective cohort study.
Han J, Li Y, Feng J … +4 more , Qi J, Wang R, Chen W, Wang J
BMC Urol · 2026 Mar · PMID 41872795 · Full text
BACKGROUND: Impacted upper ureteral stones pose a significant risk of ureteral injury and stricture formation during ureteroscopic procedures. The Flexible and Navigable Suction Ureteral Access Sheath (FANS) integrates i...
BACKGROUND: Impacted upper ureteral stones pose a significant risk of ureteral injury and stricture formation during ureteroscopic procedures. The Flexible and Navigable Suction Ureteral Access Sheath (FANS) integrates in-situ lithotripsy, continuous suction, and irrigation. This study aimed to compare the efficacy and safety of FANS with the conventional ureteroscopic technique in the management of impacted upper ureteral stones. METHODS: A single-center, retrospective cohort study was conducted involving 115 patients (FANS group: n = 50; Conventional group: n = 65). The FANS group underwent in-situ holmium laser lithotripsy with real-time irrigation and suction facilitated by FANS. The Conventional group underwent in-situ lithotripsy using a semi-rigid ureteroscope, with subsequent attempts to push stones into the renal pelvis before flexible ureteroscopic fragment extraction. The rates of ureteral stricture (within 3 months) and other perioperative parameters, including operative time, in-situ lithotripsy duration, and complications, were compared. RESULTS: Baseline characteristics were comparable between the two groups. The FANS group exhibited significantly longer operative and in-situ lithotripsy times. However, the incidence of ureteral stricture and perforation was lower in the FANS group (2% vs. 7.7% and 2% vs. 6.2%, respectively). Subgroup analyses revealed that prolonged in-situ lithotripsy time was a significant risk factor for ureteral stricture in the control group but not in the FANS group. The immediate stone-free rate was comparable between groups, with a lower rate of postoperative fever in the FANS group. CONCLUSION: For impacted upper ureteral stones, FANS assisted in-situ lithotripsy significantly reduces the risk of postoperative ureteral stricture without compromising stone clearance, offering a safer alternative to the conventional stone-pushing technique.
Investigating adult male sexual function and fertility after childhood hypospadias repair surgery - a systematic review.
Siregar S, Adriansjah R, Steven S … +1 more , Surya K
BMC Urol · 2026 Mar · PMID 41866511 · Full text
INTRODUCTION: Hypospadias, a congenital condition where the urethral opening is on the ventral of the penis, presents challenges in both diagnosis and treatment. Despite surgical advancements, long-term issues such as ps...
INTRODUCTION: Hypospadias, a congenital condition where the urethral opening is on the ventral of the penis, presents challenges in both diagnosis and treatment. Despite surgical advancements, long-term issues such as psychological distress and concerns about sexual function and fertility persist. Our study aims to systematically review sexual function and fertility outcomes in adults who underwent childhood hypospadias repair surgery, offering insights for clinical practice and future research. MATERIALS AND METHODS: This is a systematic review study. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed, Embase, and Scopus using predefined relevant keywords. Quality assessment was conducted using the Newcastle-Ottawa Scale. RESULTS: Among 288 initially identified articles, 14 meet eligibility criteria with a total of 6,737 participants for fertility outcomes and 933 for sexual function outcomes. Overall included study quality was deemed average. Distal hypospadias showed more favorable sexual function and fertility compared to severe cases that may experience issues such as ejaculation problems and infertility. CONCLUSION: Our review suggests that individuals who underwent childhood urethral repair surgery due to distal type hypospadias have more favorable sexual and reproductive outcomes than proximal hypospadias. However, proximal cases may exhibit suboptimal sexual function due to penile curvature, lower semen quality, and ejaculation function. Further multicentric research is needed to confirm these findings and guide clinical management effectively.
Flexible ureteroscopy across calyceal locations: impact of ureteroscope caliber and lower-pole anatomy on stone-free outcomes : Sheathless RIRS: Calyx Anatomy and Scope Size.
Sipal T, Suçeken FY, Sarioglu C … +3 more , Yılmaz E, Küçük EV, Sarıca K
BMC Urol · 2026 Mar · PMID 41862910 · Full text
BACKGROUND: This study compared the clinical performance of 7.5 F and 9 F digital flexible ureteroscopes in sheathless retrograde intrarenal surgery (RIRS), with a particular focus on how ureteroscope caliber interacts w...
BACKGROUND: This study compared the clinical performance of 7.5 F and 9 F digital flexible ureteroscopes in sheathless retrograde intrarenal surgery (RIRS), with a particular focus on how ureteroscope caliber interacts with lower-pole anatomy to influence stone-free outcomes. METHODS: This retrospective study included patients who underwent sheathless RIRS for single renal stones measuring 10–20 mm between October 2023 and August 2025 using either a 7.5–9 F digital flexible ureteroscope. All procedures were performed by three experienced surgeons under a standardized protocol. Stone-free status (SFR) was defined as residual fragments ≤ 4 mm on 1-month non-contrast CT. Perioperative parameters and complications were compared between groups. A prespecified lower-pole subgroup analysis examined the relationship between IPA and clearance using logistic regression and ROC analysis. RESULTS: Seventy patients were analyzed (7.5 F = 37; 9 F = 33). Overall SFRs were 78.4% and 69.7% for the 7.5 F and 9 F groups, respectively (p = 0.42). Complication rates were low and comparable. In the lower-pole subgroup, the 7.5 F scope achieved a significantly higher SFR (64.7% vs. 23.1%, p = 0.03). Multivariable analysis identified ureteroscope caliber (adjusted OR = 5.76, p = 0.036) and IPA (adjusted OR = 0.92 per degree, p = 0.017) as independent predictors of lower-pole clearance, with moderate discriminative ability for IPA (AUC = 0.682). CONCLUSION: In sheathless RIRS, smaller-caliber ureteroscopes were associated with higher stone-free rates for lower-pole stones, while overall outcomes were comparable between groups. Lower-pole anatomy was significantly associated with stone-free outcomes.
Flexible negative-pressure ureteral sheath lithotripsy compared with mini-PCNL for upper urinary tract stones with moderate-to-severe hydronephrosis: a retrospective clinical study.
Hao W, Hao J, Zhang M … +2 more , Zhang H, Yang C
BMC Urol · 2026 Mar · PMID 41857697 · Full text
BACKGROUND: Management of upper urinary tract stones with moderate-to-severe hydronephrosis remains challenging due to altered renal anatomy and higher complication risks. Flexible negative-pressure ureteral sheath litho...
BACKGROUND: Management of upper urinary tract stones with moderate-to-severe hydronephrosis remains challenging due to altered renal anatomy and higher complication risks. Flexible negative-pressure ureteral sheath lithotripsy (FANS) has emerged as a minimally invasive alternative to miniaturized percutaneous nephrolithotomy (mini-PCNL). This study compared the efficacy and safety of FANS and mini-PCNL in this patient population. METHODS: A total of 125 patients with upper urinary tract stones and moderate-to-severe hydronephrosis who underwent either FANS (n = 57) or mini-PCNL (n = 68) between June 2024 and June 2025 were retrospectively analyzed. Baseline demographics, stone characteristics, operative parameters, perioperative laboratory changes, hospital stay, immediate stone-free rate (SFR) and finial SFR, and postoperative complications were assessed. RESULTS: Baseline characteristics (age, BMI, stone burden, comorbidities, and hydronephrosis degree) were comparable between groups. The FANS group had a longer operative time (70 vs. 60 min, P = 0.006) but a shorter stay of hospital (2 vs. 3 days, P = 0.008) and smaller hemoglobin drop (8.0 vs. 11.0 g/L, P = 0.031). WBC changes, eGFR drop, immediate SFR (80.7% vs. 80.9%) and finial SFR (89.5% (51/57) vs. 88.2% (60/68)) were similar. The overall complication rate was lower with FANS (5.9% (4/57) vs. 25.0% (17/68), P = 0.011), and no severe complications occurred, whereas mini-PCNL included several Grade 3b events. CONCLUSIONS: Both FANS and mini-PCNL achieved comparable stone clearance in moderate-to-severe hydronephrosis. However, FANS offered reduced bleeding, faster recovery, and fewer complications, indicating its potential role as a safer and less invasive option for patients with complex upper urinary tract anatomy.
Bridging the gap in PCNL preoperative planning: software-free stone metrics that outperform conventional measures.
Wei B, Ning F, Fu Y … +3 more , Ji L, Gu S, Wang Y
BMC Urol · 2026 Mar · PMID 41845385 · Full text
OBJECTIVE: Accurate preoperative stone size assessment is crucial for predicting outcomes after percutaneous nephrolithotomy (PCNL), yet a gap persists between the accurate but impractical gold standard (3D software volu...
OBJECTIVE: Accurate preoperative stone size assessment is crucial for predicting outcomes after percutaneous nephrolithotomy (PCNL), yet a gap persists between the accurate but impractical gold standard (3D software volume) and the practical but suboptimal conventional metrics (maximum diameter and cross-sectional area). This study aimed to validate two novel, software-free stone size metrics—the triaxial diametric product (X) and stacked volume (V)—designed for routine clinical computed tomography (CT) and compare their efficacy in predicting the stone-free rate (SFR) against conventional methods. METHODS: We conducted a retrospective analysis of 283 patients who underwent PCNL. Stone size was measured using four metrics on pre-operative non-contrast CT: maximum diameter (R), maximum cross-sectional area (S), triaxial diametric product (X = x·y·z), and stacked volume (V). The predictive power for SFR was evaluated and compared using receiver operating characteristic (ROC) curve analysis and DeLong’s test. RESULTS: All four metrics were significant predictors of SFR (p < 0.001). The predictive accuracy, ranked by the area under the curve (AUC), was as follows: maximum diameter (R, AUC = 0.703) < maximum cross-sectional area (S, AUC = 0.734) < triaxial diametric product (X, AUC = 0.789) < stacked volume (V, AUC = 0.801). The novel metrics X and V both significantly outperformed the conventional metrics R and S (p < 0.01), with no significant difference between X and V. CONCLUSION: The triaxial diametric product (X) is recommended as a practical and more accurate alternative to conventional metrics for routine clinical practice, especially for stones > 1.5 cm, as it offers an improved balance of predictive accuracy, straightforward calculation, and easy integration into existing workflows without needing specialized software or additional costs. The stacked volume (V) serves as a feasible, software-free tool for practical size estimation in research settings. This study provides urologists with immediately applicable tools to enhance preoperative planning.
A retrospective study comparing multimodal fusion biopsy and conventional cognitive fusion biopsy for diagnosing prostate cancer.
Wu C, Jiao Z, Wu H … +5 more , Liu X, Jiang X, Wang C, Shi Y, Lv Z
BMC Urol · 2026 Mar · PMID 41845344 · Full text
BACKGROUND: Cognitive fusion targeted biopsy (cTB) is widely used in clinical practice. To advance beyond cTB, we developed a multimodal fusion targeted biopsy (mTB) system that integrates magnetic resonance imaging (MRI...
BACKGROUND: Cognitive fusion targeted biopsy (cTB) is widely used in clinical practice. To advance beyond cTB, we developed a multimodal fusion targeted biopsy (mTB) system that integrates magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion technology. This study compares prostate cancer (PCa) detection rates between these two biopsy methods, assessing the clinical utility and diagnostic accuracy of our novel fusion technique. METHOD: Our technology combines MRI and TRUS using the VENUS multimodal image fusion ultrasound system, which automatically merges imaging data, creates 3D prostate models, and performs automated analysis of suspicious lesions to guide precise biopsy planning. We retrospectively analyzed 301 patients who underwent prostate biopsies at Wujin People’s Hospital in Changzhou City from January 2023 to December 2024. All patients received 12 core systematic biopsies (SBx). When suspicious lesions were found, additional targeted biopsies (TBx) were performed. We compared clinically significant prostate cancer (csPCa) and any PCa detection rates, as well as the number of biopsy-positive cores, between the mTB group (n = 152) and the cTB group (n = 149). RESULTS: Compared to cTB, mTB significantly increased the detection rates of csPCa (48.7% vs. 32.2%, p = 0.004) and any PCa (53.3% vs. 40.9%, p = 0.032). The proportion of csPCa among all PCa cases was also higher with mTB (91.4% vs. 78.7%, p = 0.032). Patients undergoing combined TBx and SBx had a higher percentage of positive cores with mTB than with cTB (35.8% vs. 26.2%, p < 0.001), whereas no significant difference was observed in patients undergoing SBx alone. Multivariable logistic regression analysis demonstrated that mTB significantly improved PCa detection compared to cTB (p = 0.008). Furthermore, the overall rate of postoperative complications was significantly lower in the mTB group (p = 0.029). CONCLUSION: Our developed MRI-TRUS fusion technology markedly enhances detection of csPCa through precise intraoperative biopsy. Given its feasibility and accuracy, this technology holds strong potential for future clinical application.
Is MRI/US-guided fusion biopsy ready to replace systematic biopsy in detecting clinically significant prostate carcinoma? - a retrospective study.
Ökrösi A, Svarer AP, Rosta G … +2 more , Wambacher B, Heinz G
BMC Urol · 2026 Mar · PMID 41845327 · Full text
BACKGROUND: This study aims to evaluate whether MRI-US-guided FB leads to improved diagnostic accuracy compared to SB and whether SB remains necessary for the detection of csPCa, further assessing whether the TP or TR bi...
BACKGROUND: This study aims to evaluate whether MRI-US-guided FB leads to improved diagnostic accuracy compared to SB and whether SB remains necessary for the detection of csPCa, further assessing whether the TP or TR biopsy approach influences outcomes. METHODS: In this retrospective single-center study, 851patients with PI-RADS ≥ 3 lesions on mpMRI underwent combined FB and SB between June 2019 and November 2024. The highest ISUP Grade Group per patient was compared between methods. Discordant findings were analyzed, and csPCa detection rates were compared between TP and TR approaches. RESULTS: FB detected higher ISUP-GG values in 70.9% of discordant cases. csPCa (ISUP-GG 2–5) was identified in 42.2% of patients with FB compared to 28.5% with SB (p < 0.001), while rates of ciPCa were similar. FB missed PCa (ISUP-GG 1–5) in 6.5% of patients. TP biopsy demonstrated higher csPCa detection than TR biopsy (50.1% vs. 43.0%, p = 0.038). CONCLUSION: FB significantly improves detection of csPCa compared to SB. However, FB cannot yet replace SB as it would miss total PCa in 6.5% of patients, thus the use of both methods together provides the most reliable diagnosis. Further TP approach provides higher csPCa detection and should be preferred when feasible.
Crafting the graft: an umbrella review of long-term outcomes and complications for various graft usage in urethral reconstruction.
Edison EF, Birowo P, Wahyudi I … +1 more , Soeroto AA
BMC Urol · 2026 Mar · PMID 41840587 · Full text
The optimal graft choice for urethral reconstruction remains debated. This umbrella review synthesised evidence from systematic reviews and meta-analyses on graft materials, focusing on success, complications, and long-t...
The optimal graft choice for urethral reconstruction remains debated. This umbrella review synthesised evidence from systematic reviews and meta-analyses on graft materials, focusing on success, complications, and long-term outcomes. PubMed and Scopus were searched to March 2025 for reviews of patients undergoing graft-based urethral reconstruction. Eligible studies reported outcomes including success, donor-site morbidity, complications, stricture recurrence, stricture-free survival, operative efficiency, and postoperative parameters. GRADE assessed certainty, with analyses stratified by graft type and, where available, by sex or indication. Twelve reviews (2012–2025) covering 9,829 patients met criteria. Ten examined males—nine adults (three mixed etiologies, others strictures) and one pediatric hypospadias. Two included both sexes, with female cases limited to anterior strictures. Buccal mucosa grafts (BMG) were most studied, showing success > 80%. Meta-analyses found no significant difference between BMG and penile skin grafts (OR 0.83, 95% CI 0.55–1.23, I²=88%) or lingual mucosa grafts (OR 1.18, 95% CI 0.79–1.77, I²=63%). Low review quality was found in studies involving females, children, and some males, due to small sample sizes, risk of bias, lack of PROSPERO registration, and inconsistencies with meta-analysis methods, resulting in low GRADE certainty. BMG remains most effective, but evidence for women and children is scarce. Future studies should prioritise sex-stratified data, scoping reviews, and clinical algorithms.
The modified G8 screening tool to predict post-operative complications and survival after robot-assisted radical cystectomy - a pilot study.
Alhamdani Z, Obrecht F, Sethi K … +5 more , Bolton D, Froelicher G, Schregel C, John H, Foerster B
BMC Urol · 2026 Mar · PMID 41840558 · Full text
OBJECTIVE: To evaluate whether the modified G8 (mG8) screening tool predicts severe postoperative complications and 90-day mortality in patients undergoing robot-assisted radical cystectomy (RARC). METHODS: We performed...
OBJECTIVE: To evaluate whether the modified G8 (mG8) screening tool predicts severe postoperative complications and 90-day mortality in patients undergoing robot-assisted radical cystectomy (RARC). METHODS: We performed a single centre retrospective cohort study of patients who underwent RARC with ileal conduit or orthotopic neobladder diversion between 2011 and 2020 at a tertiary centre. Preoperative frailty was assessed using the mG8 score. Severe complications were defined as Clavien–Dindo grade ≥ 3. Univariable and multivariable logistic regression analyses were performed to evaluate the association of the mG8 score with severe complications and 90-day mortality. RESULTS: A total of 155 patients were included. The median age was 69 years, and 49 patients (31.6%) had an impaired mG8 score (≥ 6). Severe complications occurred in 67 patients (43.2%), and 90-day mortality occurred in 10 patients (6.5%). In univariable analysis, an impaired mG8 score was significantly associated with severe complications (OR 2.94, 95% CI 1.46–5.93, p = 0.002). After adjusting for age group, the mG8 score remained an independent predictor (OR 2.65, 95% CI 1.29–5.45, p = 0.008). An impaired mG8 score was also associated with increased 90-day mortality (OR 5.72, 95% CI 1.46–22.81, p = 0.015). Age ≥ 76 years predicted higher mortality in univariable analysis but was not associated with severe complications in adjusted models. CONCLUSION: The mG8 screening tool is a promising predictor of major postoperative complications and 90-day mortality following RARC. Frailty, rather than chronological age or comorbidity burden, appears to better identify high-risk patients. Prospective multicentre studies are warranted to validate the role of the mG8 score in preoperative risk stratification for radical cystectomy.
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