BMC Urology[JOURNAL]
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200 papers
Modified water vapor thermal therapy for large-volume benign prostatic hyperplasia.
Lu Q, Zhu G, Liu J … +5 more , Huang H, Zhang F, Qiu X, Xu L, Guo H
BMC Urol · 2026 Feb · PMID 41652420 · Full text
BACKGROUND: This study aims to evaluate the efficacy and safety of modified water vapor thermal therapy for large-volume benign prostatic hyperplasia (BPH). METHODS: This prospective study enrolled 196 consecutive patien...
BACKGROUND: This study aims to evaluate the efficacy and safety of modified water vapor thermal therapy for large-volume benign prostatic hyperplasia (BPH). METHODS: This prospective study enrolled 196 consecutive patients with prostate volume ≥ 80 mL who underwent modified water vapor thermal therapy at our institution between October 2023 and September 2024. All procedures were performed using the Rezum system. RESULTS: The procedures were successfully completed in all 196 patients with a median prostate volume of 96 mL. The IPSS decreased from a preoperative mean of 21.2 ± 3.9 to 11.7 ± 3.4 at 3 months, and further improving to 10.8 ± 3.8 at 1 year. Median prostate volume reduced from 96 mL to 60 mL. The QoL score improved from 4.3 ± 0.9 to 1.7 ± 1.1, and Qmax increased from 8.3 ± 2.3 mL/s to 15.7 ± 3.5 mL/s at 3 months. All observed improvements were statistically significant compared to baseline (P < 0.01). The IIEF-5 score increased from 11.0 ± 3.6 to 14.1 ± 5.4 at 1 year, indicating a statistically significant improvement in erectile function (P < 0.05). The incidence of retrograde ejaculation was 3.1%. Only one patient (0.5%) required surgical retreatment during the follow-up period. CONCLUSIONS: Modified water vapor thermal therapy demonstrates favorable efficacy and safety in the treatment of large-volume BPH. It is associated with significant symptom relief, functional improvement, and minimal complications.
Multimodal management of primary mixed neuroendocrine prostate cancer with bone flare phenomenon: a rare case report and therapeutic insights.
Xu L, Wang J
BMC Urol · 2026 Feb · PMID 41645109 · Full text
BACKGROUND: Neuroendocrine prostate cancer (NEPC) is a rare and aggressive subtype of prostate cancer, accounting for approximately 0.5%–2% of cases. Mixed NEPC, composed of both adenocarcinoma and neuroendocrine compone...
BACKGROUND: Neuroendocrine prostate cancer (NEPC) is a rare and aggressive subtype of prostate cancer, accounting for approximately 0.5%–2% of cases. Mixed NEPC, composed of both adenocarcinoma and neuroendocrine components, represents a biologically heterogeneous entity with limited clinical experience. CASE PRESENTATION: A 77-year-old man presented with scrotal swelling, lower urinary tract symptoms, and bilateral leg edema. Imaging demonstrated locally advanced prostate cancer with lymph node and bone metastases. Prostate biopsy revealed mixed neuroendocrine prostate cancer, consisting of neuroendocrine carcinoma and acinar adenocarcinoma (Gleason score 4 + 5=9). Immunohistochemical staining showed absence of RB, PTEN, and p53 protein expression; molecular genetic testing was not performed. The patient was treated with a multimodal regimen including androgen deprivation therapy (ADT), an androgen receptor pathway inhibitor (ARPI), docetaxel chemotherapy, and pelvic radiotherapy. During follow-up, radiographic regression of metastatic lesions and clinical improvement were observed. New bone lesions detected at two months were interpreted as a bone flare phenomenon in the overall clinical context. At seven months of follow-up, the patient remained clinically stable, with PSA levels below 0.1 ng/mL and no evidence of radiographic progression. CONCLUSION: This report describes the clinical course of a patient with mixed neuroendocrine prostate cancer managed with multimodal therapy and highlights the interpretive challenges associated with imaging changes, including the bone flare phenomenon, during treatment. Given the inherent limitations of a single case, no conclusions regarding treatment efficacy can be drawn. This case underscores the importance of cautious interpretation of PSA kinetics and imaging findings, as well as individualized, multidisciplinary management in this rare and aggressive disease.
Ileal ureter replacement for patients with long ureteral strictures after Allium stent failure: the initial experience.
Zhang Y, Wang X, Li Z … +10 more , Han G, Tao Z, Li X, Yang K, Wang B, Zhang P, Zhu H, Zhou L, Zhang K, Li X
BMC Urol · 2026 Feb · PMID 41639839 · Full text
PURPOSE: To present the initial experience and clinical outcomes of ileal ureteric replacement (IUR) for complex ureteral stricture after treatment failure of Allium stents. METHODS: From June 2020 to July 2022, a total...
PURPOSE: To present the initial experience and clinical outcomes of ileal ureteric replacement (IUR) for complex ureteral stricture after treatment failure of Allium stents. METHODS: From June 2020 to July 2022, a total of eight patients underwent IUR for complex ureteral strictures after treatment failure of Allium stents across three tertiary centers. Surgical approaches included open (n = 3), laparoscopic (n = 2), and robot-assisted (n = 3). The clinical data and follow-up results were prospectively collected. RESULTS: A total of eight patients were enrolled, including seven women and one man, with a mean age of 47.8 years. The median dwelling time of Allium stents was 12.5 months. Reasons for Allium stent failure included recurrent urinary tract infection (UTI), stent migration, unrelieved hydronephrosis and stent calculus. The median stricture length was 15 cm. Four patients underwent unilateral IUR and four underwent bilateral IUR, with a median harvested ileal segment length of 25 cm. The median operation time was 261 min and the median estimated blood loss was 75mL. During a median follow-up of 24 months, ureteral patency was achieved in all patients. The mean eGFR was 71.2 ± 34.5 preoperatively and 65.9 ± 23.9 mL/min/1.73m² at the last follow-up (p = 0.394). Two patients in the open surgery group experienced major complications, specifically ileus and incisional hernia. Long-term minor complications included UTI (n = 5) and metabolic acidosis (n = 2). CONCLUSION: Allium stents should be applied with caution and strict indications. For patients experiencing stent failure, IUR serves as a viable salvage option for managing long and complex ureteral strictures.
The Micro-hole Zone Technology as a new era in urinary drainage: a narrative review from bench to bedside.
Kennelly M, Lauridsen SV, Thiruchelvam N … +6 more , Krassioukov A, Konstantinidis C, Kastler EC, Vaabengaard R, Hornbak Landauro M, Averbeck MA
BMC Urol · 2026 Feb · PMID 41639813 · Full text
INTRODUCTION: Intermittent catheterization (IC) remains the standard of care for patients who are unable to empty their bladder. However, incomplete bladder emptying and urinary tract infections (UTIs) can persist, leadi...
INTRODUCTION: Intermittent catheterization (IC) remains the standard of care for patients who are unable to empty their bladder. However, incomplete bladder emptying and urinary tract infections (UTIs) can persist, leading to complications such as recurrent infections, episodes of hospitalizations, and decreased quality of life. The Micro-hole Zone Technology (MHZT) catheter (Luja™) represents an innovative catheter design that aims to address known mechanical risk factors for UTI by minimizing flow-stops, mucosal microtrauma, and residual urine, all key contributors to infection risk. METHOD: A scoping literature search was performed in PubMed and Google Scholar to identify all preclinical, clinical, and patient-reported outcome (PRO) studies evaluating the MHZT catheter (Luja). To contextualize its performance, findings were systematically compared with conventional two-eyelet catheters (CEC) across the same endpoints. The co-primary endpoints were (1) frequency of flow-stops and (2) residual urine volume at first flow-stop (RV1). Secondary endpoints included intracatheter pressure peaks, haematuria, and PRO measures related to comfort, ease of use, and perceived completeness of bladder emptying. RESULTS: Preclinical studies demonstrated significantly fewer flow stop with the MHZT (0% vs. up to 80% with CEC), markedly reduced residual volume at first flow-stop (mean 3.6 ± 3.9 mL vs. 38.1 ± 26.7 mL; p < 0.001) and lower intraluminal pressure peaks (− 42 ± 11 vs. − 132 ± 7 mbar; p < 0.001). From summarized data across randomized controlled trials (n > 250), catheterizations with Luja resulted in zero flow-stops and complete emptying at first flow-stop (RV1 < 10 mL) > 87% of the times compared to approximately 50% for CEC. PRO data from > 3,400 users indicated improved confidence in complete emptying, easier use and less worry for UTIs. CONCLUSION: By triangulating evidence across preclinical, clinical, and PRO studies, this review demonstrates that the MHZT/Luja catheter significantly improves bladder drainage compared with conventional designs, reducing flow-stops, residual urine, and urothelial trauma. Given that infection remains one of the most frequent IC complications, Luja offers a promising approach to lowering UTI risk factors. Enhanced user experience and confidence in complete emptying further support its potential clinical benefit.
The comparison of post-treatment quality of life after at least two years of follow-up (≥ 24 months) between robotic radical prostatectomy and radiotherapy for intermediate-risk localized prostate cancer.
Bedir S, Ünal B, Ebiloglu T … +3 more , Demiral S, Sarıkaya S, Beyzadeoğlu MM
BMC Urol · 2026 Feb · PMID 41639812 · Full text
BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RALRP) and intensity-modulated radiotherapy (IMRT) are the main curative options for localized prostate cancer (PCA). However, both may significantly affect...
BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RALRP) and intensity-modulated radiotherapy (IMRT) are the main curative options for localized prostate cancer (PCA). However, both may significantly affect patients' quality of life (QoL). OBJECTIVE: To retrospectively compare post-treatment QoL after at least 24 months of follow-up between bladder-neck- and nerve-sparing RALRP and IMRT in patients with intermediate-risk localized PCA. METHODS: A total of 164 patients treated between October 2016 and May 2023 were analyzed (104 RALRP; 60 IMRT). QoL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC-2002). Urinary, bowel, sexual, and hormonal domains were compared using appropriate statistical tests . RESULTS: Baseline demographics were similar between groups. The mean age was 68.82 ± 6.72 years in the RALRP group and 68.89 ± 7.81 years in the IMRT group. IMRT patients reported better sexual function (p < 0.05), but this advantage was counteracted by hormonal side effects due to androgen deprivation therapy (ADT). Urinary continence was comparable (p > 0.05), whereas irritative urinary symptoms were more common in IMRT (p < 0.001). Bowel function and overall satisfaction were significantly better in RALRP (both p < 0.001). CONCLUSIONS: After ≥ 24 months of follow-up, RALRP provided superior bowel and hormonal outcomes, while IMRT yielded slightly better sexual function scores. Overall satisfaction favored RALRP.
The effect of acute cold ischemia duration on testicular tissue.
Kestel M, Deliktaş H, Akarken I … +5 more , Şahin B, Dere Y, Saruhan E, Tarhan H, Şahin H
BMC Urol · 2026 Feb · PMID 41639677 · Full text
PURPOSE: Testicular cancer primarily affects men aged 15–34. Partial orchiectomy has recently emerged as a viable testis-sparing surgical technique. However, prolonged spermatic cord clamping may induce ischemia–reperfus...
PURPOSE: Testicular cancer primarily affects men aged 15–34. Partial orchiectomy has recently emerged as a viable testis-sparing surgical technique. However, prolonged spermatic cord clamping may induce ischemia–reperfusion (I/R) injury due to elevated reactive oxygen species (ROS) production. This study aimed to determine the maximum tolerable duration of testicular cold ischemia under hypothermic conditions and to evaluate its impact on ischemia–reperfusion injury in a rat model. MATERIALS AND METHODS: Thirty sexually mature Wistar albino rats were divided into four groups. Following scrotal incision and testicular cooling with ice (2–4 °C), Group I (Sham, n = 6) underwent orchiectomy. Groups II, III, and IV (n = 8 each) were subjected to 10, 20, and 30 min of ischemia, respectively, followed by 1-hour reperfusion. Biochemical parameters (TNF-α, IL-6, TAS, TOS, OSI) and histopathological evaluations, including Johnsen scoring, were conducted. RESULTS: Inflammatory markers and oxidative stress indices increased progressively with longer ischemia durations, whereas antioxidant capacity and Johnsen scores declined in a time-dependent manner. Marked biochemical and histological deterioration became evident beyond 20 min of cold ischemia, with the most severe alterations observed in the 30-minute group. CONCLUSION: In this acute rat model, cold ischemia durations beyond 20 min were associated with more pronounced early inflammatory, oxidative, and histological alterations despite hypothermic cooling. These findings suggest that limiting the duration of cold ischemia may be critical for preserving testicular tissue integrity, although confirmation in longer-term and clinically relevant models is required.
Impact of positive surgical margin location on biochemical recurrence in pT3 prostate cancer after robot-assisted radical prostatectomy: a retrospective cohort study.
Altay MS, Kocatürk H, Bedir B … +6 more , Bedir F, Cinislioğlu AE, Yeğen AF, Aydin Ö, Canda AE, Balbay MD
BMC Urol · 2026 Feb · PMID 41639660 · Full text
BACKGROUND: A positive surgical margin (PSM) following radical prostatectomy is a significant prognostic factor that increases the risk of biochemical recurrence (BCR). However, the clinical relevance of the relationship...
BACKGROUND: A positive surgical margin (PSM) following radical prostatectomy is a significant prognostic factor that increases the risk of biochemical recurrence (BCR). However, the clinical relevance of the relationship between PSM localization, its extent, and the histopathological characteristics of the tumor and BCR remains unclear. This study aimed to evaluate the association between PSM features, tumor grade, and BCR. METHODS: Patients with pathological stage pT3 who had not received adjuvant therapy were included in the study. Surgical margin status was classified according to localization, length, and the presence of an accompanying tertiary pattern. Patients were compared in terms of clinical and pathological characteristics. The development of BCR was analyzed in relation to PSA dynamics and histopathological parameters. RESULTS: The presence of PSM significantly increased BCR rates and demonstrated a strong association with tertiary pattern positivity. The tertiary pattern was observed nearly three times more frequently, particularly in patients with PSM. Cases with PSM length > 1 mm exhibited substantially higher BCR, and this parameter emerged as the strongest independent predictor of BCR. Although localization was not generally significant, apical involvement was identified as the only anatomical site associated with BCR. Differences in ISUP distributions according to PSM localization were considered notable in terms of regional tumor biology. CONCLUSIONS: PSM localization alone is not a determinant of BCR; however, PSM length, the presence of a tertiary pattern, and apical involvement provide clinically meaningful prognostic information. Therefore, detailed reporting of margin characteristics in pathology reports is critically important for accurately guiding postoperative treatment strategies.
The gut-prostate axis in benign prostatic hyperplasia: systematic review of microbial dysbiosis and pathogenic mechanisms.
Xu Y, An L, Xie J … +3 more , Luo C, Huang X, Luo G
BMC Urol · 2026 Feb · PMID 41629891 · Full text
BACKGROUND: New evidence shows that gut microbiota dysbiosis may play a crucial role in the development process of benign prostatic hyperplasia (BPH). However, at present, the specific characteristics of the gut microbio...
BACKGROUND: New evidence shows that gut microbiota dysbiosis may play a crucial role in the development process of benign prostatic hyperplasia (BPH). However, at present, the specific characteristics of the gut microbiota in patients with BPH have not been fully clarified. METHODS: The PubMed, MEDLINE and Web of Science databases were systematically searched to find the clinical and preclinical studies related to the relationship between BPH and gut microbiota from the establishment of the databases to October 7, 2025. And the studies reporting on gut microbiota and BPH were analyzed. RESULTS: A total of 10 preclinical studies and 6 clinical studies were included. These studies covered 413 patients with BPH, 338 controls, and 5 different types of BPH mouse models in total. Compared with the control group, there were significant differences in β-diversity in the BPH group. A significant increase in the Firmicutes/Bacteroidetes (F/B) ratio was regarded as a marker of the pathological condition. Specifically, changes in the abundances of Prevotella, Ruminococcus, and Lactobacillus may play a key role in the pathogenesis of the occurrence and development of BPH. The imbalance of interleukin-6 (IL-6) and interleukin-18 (IL-18), as well as changes in the levels of intestinal tight junction protein-1 and claudin-1, may also be related to the pathogenesis of BPH. CONCLUSIONS: Changes in the abundances of specific gut microbiota and their metabolites, such as an increased F/B ratio and a decreased abundance of Lactobacillus, as well as the levels of inflammatory indicators and markers of intestinal barrier dysfunction, may play a crucial role in the pathogenesis of BPH. These factors may become effective diagnostic means and potential therapeutic targets for BPH.
TOP2A drives T-cell infiltration and immune remodeling in cyclophosphamide-induced cystitis: a single-cell sequencing study with potential implications for interstitial cystitis.
Shi M, Xue W, Wen X … +1 more , Pang L
BMC Urol · 2026 Feb · PMID 41622168 · Full text
OBJECTIVE: To explore the potential mechanisms of interstitial cystitis (IC), we employed a cyclophosphamide (CYP)-induced cystitis rat model, a well-established tool for studying IC-like bladder inflammation and dysfunc...
OBJECTIVE: To explore the potential mechanisms of interstitial cystitis (IC), we employed a cyclophosphamide (CYP)-induced cystitis rat model, a well-established tool for studying IC-like bladder inflammation and dysfunction. This study aimed to investigate the role of rhythmic genes and immune microenvironment remodeling in this model, focusing on TOP2A and its impact on T-cell infiltration. METHODS: CYP-induced cystitis rat models were established using cyclophosphamide. Single-cell RNA sequencing was performed on bladder tissues to analyze cellular heterogeneity. Differentially expressed genes (DEGs) and weighted gene co-expression network analysis (WGCNA) identified rhythmic and immune-related gene clusters. TOP2A was validated via RT-PCR, Western blot, and immunohistochemistry (IHC). Statistical analyses assessed correlations between TOP2A, CD4 + T cells, and CD8 + T cells. RESULTS: Single-cell sequencing revealed elevated T-cell infiltration in a CYP-induced cystitis rat model. TOP2A was the sole overlapping gene between rhythmic and immune clusters and showed significant upregulation in IC tissues (P < 0.05). IHC confirmed increased TOP2A, CD4 + T, and CD8 + T cell levels, with strong positive correlations (r = 0.89 and 0.64, respectively). Functional enrichment linked TOP2A to oxidative phosphorylation and ribosomal pathways. CONCLUSIONS: Our findings demonstrate that TOP2A drives immune dysregulation in CYP-induced cystitis by modulating T-cell infiltration. As T-cell infiltration is a hallmark of human IC, our findings in this CYP-induced model suggest that TOP2A may represent a novel therapeutic target worthy of further investigation in human IC tissues.
A novel assistive device for enhancing extracorporeal shockwave lithotripsy in obese patients with distal ureteral stones.
Zhang M, Liu P, Wang Q … +4 more , Chang F, Li T, Niu Y, Hu H
BMC Urol · 2026 Jan · PMID 41620587 · Full text
BACKGROUND: Obesity significantly increases the risk of developing urinary tract stones, particularly distal ureteral stones, which can complicate treatment with extracorporeal shockwave lithotripsy (SWL). In obese patie...
BACKGROUND: Obesity significantly increases the risk of developing urinary tract stones, particularly distal ureteral stones, which can complicate treatment with extracorporeal shockwave lithotripsy (SWL). In obese patients, the distance between the skin and the stone often exceeds the effective shockwave range, reducing SWL efficacy. This study presents an innovative SWL assistive device designed to address this challenge by using natural body passages such as the rectum or vagina to shorten the distance between the skin and the stone. METHODS: Three obese patients with distal ureteral stones who were initially unsuitable for conventional SWL due to excessive skin-to-stone distance were included. An assistive device was used via natural body passages to reduce the skin-to-stone distance during SWL. Clinical outcomes were assessed by postoperative imaging. Descriptive analysis was performed. RESULT: In three obese patients with distal ureteral stones, the use of the device allowed SWL to be performed effectively, with no residual stones detected on follow-up imaging. The device has been patented in China (Patent No.: ZL 2020 2 2018950.0) and is undergoing larger-scale clinical trials to further evaluate its safety and efficacy. CONCLUSIONS: This development offers a promising solution for obese patients who were previously unable to undergo effective SWL treatment. TRIAL REGISTRATION: Not applicable.
Comparison of clinical outcomes between metallic and polymeric ureteral stents in malignant ureteral obstruction: a retrospective comparative study.
Nishi T, Nakazawa R, Morimoto Y … +6 more , Yamada R, Tsukada H, Shirai D, Yoza N, Aida K, Kikuchi E
BMC Urol · 2026 Jan · PMID 41618268 · Full text
BACKGROUND: The present study compared the clinical outcomes and indications of metallic ureteral stents (MS) and polymeric ureteral stents (PS) in patients with malignant ureteral obstruction (MUO). METHODS: We analyzed...
BACKGROUND: The present study compared the clinical outcomes and indications of metallic ureteral stents (MS) and polymeric ureteral stents (PS) in patients with malignant ureteral obstruction (MUO). METHODS: We analyzed 148 patients (240 ureters) with MUO who underwent ureteral stent placement at our Department of Urology between December 2014 and April 2022. The cohort included 67 patients (112 ureters) who received metallic stents (MS group) and 81 patients (128 ureters) who received polymeric stents (PS group). We evaluated overall survival and the primary underlying malignancies, and compared operative times, ureteral stent patency rates, and factors associated with stent obstruction between the two groups. RESULTS: The one-year overall survival rate of patients with MUO was 27.2%, with a median survival time of 209 days. The main primary malignancies were gynecologic and gastrointestinal cancers, most commonly cervical, gastric, colorectal, breast, and ovarian cancers, in that order. The operative time for stent insertion was significantly longer in the MS group than in the PS group for both bilateral (p = 0.0004) and unilateral (p = 0.0094) placements. The one-year stent patency rate was significantly higher in the MS group (62.0%) than in the PS group (48.5%) (p = 0.0144). Factors associated with stent obstruction included lower ureteral obstruction (p = 0.0401), direct tumor compression (p = 0.0172), pyuria (p = 0.0028), and elevated preoperative serum creatinine (p = 0.0088) in the MS group, and peritoneal dissemination (p = 0.0005) in the PS group. A comparison of stent patency between the groups according to obstruction factors showed no significant differences for lower ureteral obstruction (p = 0.5140), direct tumor compression (p = 0.8215), or pyuria (p = 0.8401). However, among patients with peritoneal dissemination, the stent patency period was significantly longer in the MS group (p = 0.0001). CONCLUSIONS: Metallic ureteral stenting, which has higher patency rates than PS, is a safe and effective treatment option for MUO, particularly in the patients with peritoneal dissemination.
Effects of dutasteride with Bacillus Calmette-Guérin therapy on recurrence, progression, metastasis, and survival in non-muscle invasive bladder cancer: a retrospective single-center study.
Nebioğlu A, Başaranoğlu M, Bozlu M … +2 more , Tek M, Akbay E
BMC Urol · 2026 Jan · PMID 41606559 · Full text
BACKGROUND: To evaluate the impact of dutasteride, a 5-alpha reductase inhibitor, used alongside intravesical Bacillus Calmette-Guérin therapy on recurrence, progression, metastasis, and disease-free survival in non-musc...
BACKGROUND: To evaluate the impact of dutasteride, a 5-alpha reductase inhibitor, used alongside intravesical Bacillus Calmette-Guérin therapy on recurrence, progression, metastasis, and disease-free survival in non-muscle invasive bladder cancer patients. METHODS: A retrospective analysis was conducted on 514 male non-muscle invasive bladder cancer patients treated at a tertiary care Urology Clinic from January 1, 2015, to January 1, 2023. All participants received intravesical Bacillus Calmette-Guérin therapy induction therapy weekly for six weeks post-transurethral bladder tumor resection, followed by maintenance therapy. Sociodemographic data were collected, and patients were divided into dutasteride users and non-users. Propensity Score Matching minimized group differences. Survival times were assessed using the Kaplan-Meier method, and Cox regression models were applied for further analysis. RESULTS: Of the 514 patients, 257 used dutasteride. Median follow-up time was 67 months (IQR: 48–89 months). Dutasteride users were associated with significantly improved disease-free survival, recurrence-free survival, and progression-free survival (all p < 0.001). Metastasis incidence was significantly lower in dutasteride users (p < 0.001). Incidental bladder cancer detection rates during BPH assessment were similar between groups (28.4% vs. 28.4%). CONCLUSIONS: Dutasteride use, in conjunction with transurethral bladder tumor resection and Bacillus Calmette-Guérin therapy, is associated with improved survival outcomes and reduced metastasis risk in non-muscle invasive bladder cancer patients, suggesting its potential as an adjuvant therapeutic option. TRIAL REGISTRATION: Not applicable.
ZJU index and the prevalence of kidney stones in US adults: evidence from NHANES 2007-2018.
Zhong S, Li G, Tian C … +5 more , Ding T, Jiang M, Diao P, Gan L, Ning L
BMC Urol · 2026 Jan · PMID 41606548 · Full text
BACKGROUND: Kidney stones represent a prevalent urinary tract condition frequently observed in individuals with metabolic disturbances. The Zhejiang University (ZJU) Index, a composite metabolic indicator, has been propo...
BACKGROUND: Kidney stones represent a prevalent urinary tract condition frequently observed in individuals with metabolic disturbances. The Zhejiang University (ZJU) Index, a composite metabolic indicator, has been proposed for metabolic evaluation; however, its connection with the occurrence of kidney stones has yet to be thoroughly investigated. METHODS: This cross-sectional analysis utilized data from the 2007-2018 National Health and Nutrition Examination Survey (NHANES) to explore the association between the ZJU Index and kidney stone status. Multivariate logistic regression models were employed to estimate independent associations. Restricted cubic spline (RCS) and segmented regression methods were applied to characterize potential nonlinear trends. Robustness of findings was further examined through subgroup stratification and sensitivity procedures. RESULTS: Among 14,593 participants, 1,401 reported a history of kidney stones. After adjustment for potential confounders, higher ZJU Index values were positively associated with kidney stone prevalence (odds ratio [OR] per 1-unit increase, 1.03; 95% confidence interval [CI], 1.03-1.04). Compared with the lowest quartile, the adjusted ORs for kidney stone prevalence were 1.45 (95% CI, 1.12-1.89), 1.75 (95% CI, 1.33-2.29), and 2.14 (95% CI, 1.62-2.82) across increasing ZJU Index quartiles (P for trend < 0.001). Restricted cubic spline analyses suggested a non-linear association, with a steeper increase at lower to moderate ZJU Index levels and attenuation of the association at higher levels. These associations were consistent across demographic subgroups and sensitivity analyses. CONCLUSION: In U.S. adults, elevated ZJU index levels are nonlinearly and positively associated with the prevalence of kidney stones, suggesting that the ZJU index may serve as a potential metabolic indicator for assessing urolithiasis risk. Given the routine availability and accessibility of its component variables, the ZJU index holds promise as a valuable tool for epidemiological screening and metabolic risk management in populations at high risk for kidney stones.
Bipolar resection versus enucleation of the prostate in management of benign prostatic hyperplasia patients with large-sized prostates: a prospective randomized controlled clinical trial.
Mostafa MM, Ibrahim AF, Moeen AM … +3 more , Elgammal MA, El-Azab AS, Faragallah MA
BMC Urol · 2026 Jan · PMID 41580733 · Full text
BACKGROUND: Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hyperplasia (BPH), but its efficacy decreases in large prostates. Bipolar enucleation of the prostat...
BACKGROUND: Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hyperplasia (BPH), but its efficacy decreases in large prostates. Bipolar enucleation of the prostate (BipolEP) has been introduced as a modification enabling complete adenoma removal and potentially superior outcomes. This study compared the efficacy and safety of bipolar TURP (B-TURP) and BipolEP in patients with large prostate volumes (≥ 80 mL). PATIENTS AND METHODS: Seventy patients with prostate volume ≥ 80 mL and bladder outlet obstruction were prospectively randomized to undergo either B-TURP (n = 37) or BipolEP (n = 33). Both procedures were performed using standardized bipolar platforms. Postoperative management followed uniform bladder irrigation and catheterization protocols. Primary outcomes were functional parameters (IPSS, Qmax, PVR), while secondary outcomes included perioperative parameters and complications. ANCOVA analysis adjusting for baseline IPSS and Qmax, and Post-hoc power analysis were performed. RESULTS: Both groups showed significant postoperative improvement in IPSS, Qmax, and PVR (p < 0.001). Compared with B-TURP, BipolEP achieved a greater reduction in IPSS (p = 0.04) and higher postoperative Qmax (p = 0.004). Operative time, irrigation volume, catheterization duration, and residual tissue were all significantly lower in the BipolEP group (p < 0.05). Retrograde ejaculation occurred more frequently after BipolEP (81.8% vs. 48.6%, p = 0.004), whereas other complications were comparable. ANCOVA confirmed that between-group differences in IPSS and Qmax remained significant after adjusting for baseline values. CONCLUSION: In patients with large prostates, BipolEP offers superior functional outcomes and improved perioperative efficiency compared with B-TURP, though at a higher risk of retrograde ejaculation. These findings support BipolEP as a preferred surgical option for large-volume BPH. TRIAL REGISTRATION: The study is registered in clinical trials (ClinicalTrials gov ID: NCT05330156 ; Registered on April 15, 2022).
Development and external validation of nomograms for predicting prostate cancer and clinically significant prostate cancer in patients with PSA between 4 and 20 ng/mL.
Wu K, Ye C, Liu Z … +5 more , Zhang Y, Xiao D, Ba J, Chen H, Huang S
BMC Urol · 2026 Jan · PMID 41580657 · Full text
BACKGROUND: This study aimed to develop and externally validate nomograms for predicting prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in patients with prostate-specific antigen (PSA) between 4...
BACKGROUND: This study aimed to develop and externally validate nomograms for predicting prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in patients with prostate-specific antigen (PSA) between 4 and 20 ng/mL. METHODS: Nomograms were developed using data from patients with PSA of 4–20 ng/mL who underwent prostate MRI and biopsy at our institution (n = 440). The outcomes were the presence of csPCa and PCa. Significant variables identified through univariate logistic analysis and LASSO regression analysis were used to construct four nomograms separately for lesions located in the peripheral and transitional zones. These nomograms were subsequently validated and evaluated using an external independent cohort of patients obtained from the Prostate Imaging: Cancer AI (PI-CAI) database (n = 313). RESULTS: Age, Prostate Imaging Reporting and Data System (PI-RADS) score, apparent diffusion coefficient (ADC) value, and PSA density (PSAD) were independent predictors in the prediction model for csPCa in the peripheral zone (PZ), showing an area under the curve (AUC) of 0.934 in the external validation cohort. For csPCa in the transitional zone (TZ), PI-RADS score, ADC value, and PSAD were independent predictors, with an AUC of 0.903. Additionally, PI-RADS score and ADC value were independent predictors for PCa in PZ, with an AUC of 0.882, while PI-RADS score and PSAD were independent predictors in TZ, with an AUC of 0.764. Calibration curves indicated good agreement, and decision curve analyses (DCAs) confirmed the clinical benefits of the nomograms. CONCLUSION: Our diagnostic nomograms are simple, feasible, and demonstrate strong performance in predicting csPCa and PCa.
Impact of Elmiron adjunct therapy on outcomes of fulguration in chronic interstitial cystitis in women.
Yeni S, Kilciler M
BMC Urol · 2026 Jan · PMID 41578241 · Full text
BACKGROUND: Interstitial cystitis (IC), particularly in patients with Hunner-type lesions, is a chronic, debilitating condition with limited treatment success. While bladder fulguration and pentosan polysulfate sodium (P...
BACKGROUND: Interstitial cystitis (IC), particularly in patients with Hunner-type lesions, is a chronic, debilitating condition with limited treatment success. While bladder fulguration and pentosan polysulfate sodium (PPS, Elmiron) are established treatments, their combined efficacy has not been systematically studied. OBJECTIVE: To evaluate whether adjunctive Elmiron therapy enhances the therapeutic outcomes of fulguration in female patients with Hunner-type IC. METHODS: A total of 97 female patients with Hunner-type IC who underwent bladder fulguration between 2022 and 2024 were included in this retrospective analysis of prospectively collected data. Group 1 (n = 49) received Elmiron therapy for 6 months postoperatively, while Group 2 (n = 48) did not. Patients were followed for 12 months, and outcomes were assessed using the Visual Analogue Scale (VAS), Interstitial Cystitis Symptom Index (ICSI), and Interstitial Cystitis Problem Index (ICPI). RESULTS: No statistically significant differences were observed between groups in VAS scores at any time point. However, Group 1 showed a significantly greater reduction in ICSI scores at 12 months (p = 0.023) and in ICPI scores at both 6 months (p = 0.040) and 12 months (p < 0.001). Percentage change analyses confirmed a more pronounced improvement in symptom and problem indices in the Elmiron group at 12 months. CONCLUSION: Adjunctive Elmiron therapy appears to enhance the long-term symptom and problem index outcomes of fulguration in women with Hunner-type interstitial cystitis. Further large-scale, multicenter studies are warranted to optimize treatment protocols and establish standardized guidelines for this combination approach.
Predictive value of neutrophil to lymphocyte ratio for the clinical outcome of patients with ureteral stones: a systematic review and meta-analysis.
Chen W, Cao Z
BMC Urol · 2026 Jan · PMID 41566285 · Full text
OBJECTIVES: This study presents the first systematic review and meta-analysis assessing the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on the clinical outcomes in individuals with ureteral stones. METHO...
OBJECTIVES: This study presents the first systematic review and meta-analysis assessing the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on the clinical outcomes in individuals with ureteral stones. METHODS: Relevant studies were systematically identified through searches in PubMed, Embase, Web of Science, and Cochrane, covering publications up to January 2025, focusing on studies that assessed the predictive role of NLR in the clinical outcomes of individuals with ureteral stones. Outcomes included spontaneous stone passage (SSP) and ureteric sepsis. Predictive data for SSP were derived from a cohort of patients receiving conservative medical treatment, while predictive data for ureteric sepsis were derived from a cohort of patients receiving surgical treatment. Sensitivity and subgroup analysis were conducted to evaluate the stability of the results and possible sources of heterogeneity. RESULTS: 10 cohort studies involving 4,859 patients with ureteral stones were analyzed in this meta-analysis. The meta-analysis of multivariate data showed that SSP rate was significantly lower in the high NLR group compared to the low NLR group (OR: 0.46; 95% CI: 0.33, 0.64; P <0.00001), and the risk of ureteric sepsis in the high NLR group was significantly higher than that in the low NLR group (OR: 2.50; 95% CI: 1.31, 4.76; P = 0.005). Subgroup analysis suggested that the prognostic value of NLR for patients with ureteral calculi was not affected by stone size and NLR cut-off value. CONCLUSIONS: NLR can be used as an independent predictor of the SSP and the risk of ureteric sepsis in patients with ureteral stones. Future large-scale, multicenter, prospective clinical studies are necessary to further confirm the relationship between NLR and the clinical outcomes of patients with ureteral stones. CLINICAL TRIAL NUMBER: Not applicable.
Estimation of IPSS and OABSS scores using ChatGPT-4o: a comparative validation study in Korea.
Bae H, Lee GM, Lee J … +5 more , Lee JH, Yoo S, Cho MC, Jeong H, Son H
BMC Urol · 2026 Jan · PMID 41555309 · Full text
PURPOSE: To evaluate the performance of ChatGPT-4o in estimating International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) based on patients’ natural language descriptions and full outpatie...
PURPOSE: To evaluate the performance of ChatGPT-4o in estimating International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) based on patients’ natural language descriptions and full outpatient records, compared to actual questionnaire scores. MATERIALS AND METHODS: This study included 91 patients, of whom 52 completed IPSS and 77 completed OABSS. ChatGPT-4o was prompted with verbatim symptom statements and full medical records written by a urologist. Predicted scores were compared to actual scores using paired t-tests, weighted Cohen’s kappa for item-level agreement, Spearman’s correlation for total scores, and Bland–Altman plots for bias. Diagnostic classifications (lower urinary tract symptoms [LUTS]: IPSS ≥8; overactive bladder [OAB]: OABSS ≥3 with urgency ≥2) were assessed using McNemar’s test and receiver operating characteristic curve analysis. RESULTS: Mean IPSS scores estimated by ChatGPT-4o were statistically significantly lower than patient-reported scores (11.2 vs. 13.6, p = 0.006), whereas OABSS scores did not differ significantly between the two methods (6.99 vs. 6.86, p = 0.686). Diagnostic agreement was high: LUTS in 42 (actual) vs. 38 (GPT) patients, and OAB in 51 vs. 50 patients. Area under curve was 0.81 for IPSS and 0.91 for OABSS. Kappa values ranged from 0.23–0.81 (IPSS) and 0.44–0.71 (OABSS), with highest concordance in quality of life (QoL) and urgency incontinence. Spearman’s correlation coefficient was 0.60 (IPSS) and 0.70 (OABSS). Accuracy was lower in first-visit patients. CONCLUSIONS: GPT-4o estimated IPSS and OABSS with moderate but clinically acceptable accuracy. Its performance was comparable regarding diagnostic classification, particularly for QoL and OABSS. ChatGPT-4o may complement traditional questionnaires, particularly with missing or incomplete patient-reported data.
Prognostic significance of neuroendocrine differentiation and PD-L1 expression in treatment-naïve prostate cancer.
Tosun I, Sahin O, Bakkaloğlu İG … +2 more , Şişik NM, Özçelik M
BMC Urol · 2026 Jan · PMID 41547728 · Full text
PURPOSE: Prostatic adenocarcinoma with neuroendocrine differentiation (PaNED) is distinct from treatment-related and de-novo neuroendocrine prostate carcinomas, yet remains under-investigated in treatment-naïve patients....
PURPOSE: Prostatic adenocarcinoma with neuroendocrine differentiation (PaNED) is distinct from treatment-related and de-novo neuroendocrine prostate carcinomas, yet remains under-investigated in treatment-naïve patients. This study aimed to evaluate the associations of NED extent, synaptophysin intensity score (SIS), and PD-L1 expression with other histomorphological features and prognosis in treatment-naïve PaNED. MATERIALS AND METHODS: Seventeen patients with PaNED diagnosed between 2014 and 2024 were retrospectively analyzed. NED was classified as diffuse (≥ 30%) or focal (< 30%), and SIS was scored as weak (+ 1), moderate (+ 2), or strong (+ 3). PD-L1 expression was assessed using tumor proportion score (TPS, cut-off ≥ 1%) and combined positive score (CPS, cut-off ≥ 10). Clinicopathological data and survival outcomes were evaluated. RESULTS: The mean age was 65.2 ± 6.6 years, and 47.1% (n = 8) of the cases were Grade Group 5. Diffuse NED was observed in 70.6% of cases, and strong synaptophysin expression in 35.3%. PD-L1 TPS and CPS positivity were detected in 17.6% and 35.3% of patients, respectively. Neither NED extent nor percentage was significantly associated with PD-L1 expression or prognosis. A moderate negative correlation was found between SIS and PD-L1 CPS (rho = -0.48, p = 0.051). Strong synaptophysin expression was significantly associated with shorter overall survival (p = 0.031). CONCLUSIONS: In treatment-naïve PaNED, higher SIS was correlated with lower PD-L1 CPS values, and strong synaptophysin expression was associated with poorer survival. Assessment of SIS in morphologically suspected neuroendocrine areas may provide additional prognostic information and help predict the PD-L1 response. Larger studies are required to validate these findings.
Treatment preferences of patients and physicians for early-stage and adjuvant treatment of urothelial carcinoma and renal cell carcinoma in Asia-Pacific: a discrete choice experiment.
Chiong E, Spain L, Patel MI … +8 more , Ong TA, Wang SS, Tsai YC, Chan E, Vandervoort L, D'Souza A, Gokhale S, Teoh JY
BMC Urol · 2026 Jan · PMID 41546020 · Full text
INTRODUCTION: The management of early-stage and adjuvant UC and RCC has undergone a paradigm shift with the availability of multiple treatment options. However, there is limited understanding about the treatment attribut...
INTRODUCTION: The management of early-stage and adjuvant UC and RCC has undergone a paradigm shift with the availability of multiple treatment options. However, there is limited understanding about the treatment attributes preferred by patients and physicians in these settings in Asia-Pacific. METHODS: This cross-sectional web-based discrete choice experiment (DCE) survey aimed to assess treatment preferences for early-stage and adjuvant UC and RCC in Asia-Pacific. Participants were patients (aged ≥ 18 years, RCC: n=50, UC: n=50) and physicians (medical oncologists: n=46; urologists: n=44). The DCE included 8 attributes covering efficacy, risks of treatment-related adverse events (TRAEs), and mode of administration (MOA). Relative preference weights, relative importance (RI), and minimum acceptable benefit were analyzed using hierarchical Bayesian logistic regression. RESULTS: Both patients and physicians placed higher importance on efficacy attributes: one-year disease-free survival (DFS) (patients: RI=25.1%; physicians: RI=36.3%) and overall survival (OS) (patients: RI=27.6%; physicians: RI=22.1%). Among patients, this was followed by risks of treatment-related fatigue (RI=9.9%), and risk of long-term/permanent TRAEs (RI=9.4%). For physicians, it was risk of treatment-related skin rash (RI=8.5%) and risk of treatment-related fatigue (RI=8.0%). Patients would accept a 5-35% risk increase in treatment-related fatigue for 11.4% DFS/0.67-year OS increase, and a 1-15% risk increase in long-term/permanent TRAE (1%-15%) for 10.8% DFS/0.64-year OS increase. Physicians would accept 5-25% risk increases in treatment-related skin rash for 8.0% DFS/0.74-year OS increase and in fatigue for 6.1% DFS/0.56-year OS increase. Most patients (87-92%) and physicians (88-96%) would initiate earlier systemic treatment for UC/RCC than at the advanced or metastatic stage. CONCLUSION: Patients and physicians valued efficacy attributes over TRAE-attributes. Both groups would trade higher risks for greater efficacy, though these trade-offs vary based on TRAE type. This indicates a need for shared decision-making for early-stage and adjuvant UC and RCC in Asia-Pacific.
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