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Background: Radical prostatectomy (RP) is a widely used treatment for localized prostate cancer, where achieving negative surgical margins is essential to reduce the risk of biochemical recurrence (BCR) and avoid additional treatments like radiation therapy. Positive surgical margins (PSMs) are associated with increased recurrence rates, higher costs, and patient anxiety. This review aims to evaluate real-time technologies for surgical margin assessment during RP, focusing on their clinical utility, advancements, and potential to improve intraoperative decision-making.
Methods: A non systematic review was conducted by searching PubMed/MEDLINE and Google Scholar for studies on realtime intraoperative margin assessment technologies in RP, including traditional and emerging methods. The review assessed technologies such as frozen section analysis, Confocal Laser Endomicroscopy (CLE), Fluorescence Confocal Microscopy (FCM), Optical Spectroscopy, and Augmented Reality (AR). Data from clinical trials and studies were analyzed based on their sensitivity, specificity, operational feasibility, and potential to reduce PSMs.
Results: Emerging technologies like CLE and FCM have shown significant potential for intraoperative tissue imaging, offering high-resolution, real-time feedback that can help identify cancerous tissue and guide surgical margins. Frozen section analysis remains the gold standard for intraoperative assessment due to its high sensitivity and specificity, but it is time-consuming and dependent on specialized pathology teams. AR, CLE, and optical spectroscopy technologies are gaining attention for their ability to provide real-time data and improve surgical precision. However, challenges such as high costs, technical complexity, and limited availability in resource-limited settings hinder broader adoption. Further clinical validation is needed to confirm their effectiveness and feasibility.
Conclusions: Real-time assessment technologies offer promising advancements in reducing PSMs during RP, potentially improving both oncological and functional outcomes. While frozen section analysis remains the most widely used method, emerging technologies like CLE, FCM, AR, and optical spectroscopy show promise in enhancing surgical precision and patient outcomes. Continued innovation and large-scale clinical trials are crucial for integrating these tools into standard clinical practice and making them more accessible to a broader patient population.
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Background: Overactive bladder (OAB) is a common condition characterised by urgency, frequency and nocturia, with a substantial effect in quality of life. Home-based posterior tibial nerve stimulation (PTNS) using the TENSI+ device represents a non-invasive alternative to conventional therapies. This study aimed to evaluate the short-term clinical effectiveness, feasibility and safety of home-based transcutaneous PTNS (T-PTNS) in patients with OAB and detrusor overactivity (DO).
Methods: A prospective, single-arm study was conducted in Barcelona (September 2024–October 2025). Adults with OAB, defined in accordance with the International Continence Society criteria and urodynamic DO or cystometric capacity < 250 mL, received T-PTNS (10 Hz, 200 µs, individualised sensory threshold; 20 min/day, 5 days/week for 12 weeks). Outcomes included OAB-V8, OAB-V3, ICIQ-SF, Bladder Control Self-Assessment Questionnaire (BCSAQ) and safety and adherence. Logistic regression was used to identify predictors of early discontinuation.
Results: Thirty-one patients were enrolled (mean age 70.5 ± 18.2 years; 58.1% women), and 71% completed the protocol. Significant improvements were observed from baseline to week 12 in OAB-V8 (24.0 → 13.1; p < 0.001), OAB-V3 (8.7 → 4.7; p < 0.001), ICIQ-SF (10.7 → 6.4; p = 0.019), BCSAQ-Symptoms (7.5 → 4.3; p < 0.001) and BCSAQ-Bother (8.1 → 5.0; p = 0.005). Clinical benefits were evident by week 4 and consolidated by week 12, with a consistent effect across sex subgroups. No device-related adverse events were reported. Early discontinuation was associated with baseline ICIQ-SF ≥ 12, BCSAQ ≥ 20 and cystometric capacity < 200 mL.
Conclusions: Home-based T-PTNS with the TENSI+ device resulted in significant short-term improvements in urgency, frequency and incontinence, with excellent safety and good adherence. Benefits emerged within 4 weeks, and they were sustained through 12 weeks, supporting TENSI+ as a feasible ambulatory neuromodulation option for selected patients with OAB. Larger randomised trials are warranted to confirm long-term efficacy and cost-effectiveness.
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Background: Accurate prognostic tools are essential for guiding therapeutic decisions and follow-up strategies in patients with urothelial bladder cancer undergoing radical cystectomy. Although decision tree models have shown promise in predicting cancer-specific outcomes, their clinical utility depends on external validation across diverse populations. This study aimed to externally validate a previously published decision tree model for predicting cancer-specific mortality using an independent multi-centre cohort from south-east Spain.
Methods: A multi-centre retrospective cohort study was conducted across five university hospitals in south-east Spain. A total of 553 patients with histologically confirmed urothelial bladder cancer who underwent standard radical cystectomy between 2004 and 2025 were included. A decision tree model originally developed using the Surveillance, Epidemiology, and End Results (SEER) database to predict cancer-specific survival was externally validated. The development and validation cohorts were comparatively analysed using chi-square tests and analysis of variance. Model discrimination was assessed using the concordance index (C-index) and calibration plots. Clinical utility was evaluated using decision curve analysis (DCA).
Results: The C-index was 0.733 in the Spanish validation cohort, indicating good discriminative performance. DCA demonstrated a net benefit of using the model over a “treat-all” strategy at threshold probabilities >25%. Despite demographic and staging differences between the validation and original cohorts, the model maintained its predictive accuracy.
Conclusions: This study provides formal external validation of a decision tree model for predicting cancer-specific mortality after radical cystectomy, demonstrating robust performance and supporting its use in clinical settings in south-east Spain.
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Objective: We aimed to evaluate the impact of the abscess-to-kidney surface area ratio, inflammatory biomarkers, and comorbidities on treatment decisions in renal abscess management, beyond the traditional size-based approach.
Methods: This retrospective cohort study included 41 adult patients with radiologically confirmed renal or perirenal abscesses between 2016 and 2025. Patients were categorized into three groups: medical therapy only, minimally invasive drainage, and invasive surgical intervention. Abscess size, contact surface ratio, and laboratory parameters (e.g., neutrophil-to-lymphocyte ratio (NLR), albumin) were analyzed. Multinomial logistic regression and subgroup analyses were performed to identify predictors of treatment modality.
Results: The mean abscess diameter was significantly different across treatment groups (p < 0.001), with a higher rate of invasive interventions in abscesses >60% of the kidney surface. Elevated NLR was an independent predictor of invasive treatment in the multivariate model. While lower albumin levels were observed in univariate analysis among patients requiring invasive therapy, this association was not independent in the adjusted model. Diabetes mellitus was significantly more prevalent among patients requiring invasive therapy (p = 0.002). Among patients with 30–60% surface area involvement, NLR was significantly higher in those requiring surgical intervention (p = 0.014). The regression model demonstrated good predictive performance.
Conclusions: A multidimensional treatment algorithm that integrates abscess-to-kidney surface area ratio, systemic inflammatory response, and comorbid conditions may guide optimal therapy for renal abscesses. Particularly in intermediate-sized abscesses, laboratory markers such as NLR and albumin may help identify candidates for early intervention, potentially avoiding delayed or insufficient treatment.
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Background: The optimal preoperative drainage strategy for ureteropelvic junction obstruction remains controversial. This study compares the outcomes between different preoperative urinary drainage methods in robot-assisted pyeloplasty (RAPY).
Methods: This retrospective study was conducted on 45 patients who underwent RAPY from 2020 to 2024 and categorised by clinical presentation: flank pain with hydronephrosis requiring preoperative urinary drainage double-J ureter catheter (DJ) or percutaneous nephrostomy (PCN) or renal function deterioration (no-drain) scheduled for pyeloplasty. The patients were divided into three groups: DJ (n = 10), PCN (n = 10) and no preoperative catheter (n = 25). Primary endpoint was the occurrence of complications within 90 days after surgery. Secondary endpoints included console time, hospitalisation rates, improvement in glomerular filtration rate (GFR) (compared between baseline GFR and GFR at discharge) and readmission rates.
Results: The immediate GFR improvement after surgery was 2.57 mL/min/1.73 m 2 (p = 0.62). Complications were observed in 30% of the PCN group, 32% of the no-drain group (p = 0.18) and none in the DJ group (0%). Five major complications occurred, four of them in the no-drain group. One was incisional hernia, and one was subcutaneous hematoma. In three patients, the intraoperatively inserted DJ catheter had to be replaced postoperatively. All replacements took place in the no-drain group. Six patients were readmitted within 90 days postoperatively (three each in the PCN and no preoperative catheter groups).
Conclusions: Short-term, preoperative, X-ray-guided DJ catheter placement appears to be a safe approach for adult pyeloplasty preparation to prevent postoperative complications associated with blind DJ insertion. It can also help in avoiding the effects of long-term stenting. Placing a nephrostomy catheter is another reasonable option. Further prospective studies are needed to validate our findings.
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Introduction: Laparoscopic-assisted renal cryoablation (LRC) is a treatment option for small renal masses (SRMs), offering a nephron-sparing alternative to partial nephrectomy. This study evaluated long-term oncologic outcomes and perioperative complications after LRC in a single-center cohort.
Methods: We conducted a retrospective single-center review of 52 patients who underwent LRC for SRMs ≤4 cm between 2006 and 2015. Primary outcomes included local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). Secondary outcomes included 90-day postoperative complications graded by the Clavien-Dindo system.
Results: The 5- and 10-year LRFS were 90% (95% Confidence Interval (CI) 86-94%) and 90% (95% CI 86–94%), and MFS were 94% (95% CI 92–97%) and 94% (95% CI 92–97%), respectively. OS for patients with malignant histology was 87% (CI 82– 91%). Approximately 30% of patients had benign tumors. The overall complication rate was 21%. No perioperative mortality occurred.
Conclusions: LRC provided effective long-term local tumor control with acceptable complication rates in patients with SRMs. However, the lack of preprocedural biopsy led to overtreatment of benign tumors. The findings highlight the importance of histologic confirmation prior to ablation.
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Background: Urge urinary incontinence (UUI) is a persistent and disabling condition that occurs in Overactive Bladder (OAB) patients without evidence of urinary tract infection (UTI). At our institution, intradetrusor injections of onabotulinumtoxinA (BTX-A) are implemented as a second-line therapy for patients in whom pharmacological management has failed.
Methods: Between January 2020 and March 2023, 62 patients (38 women, 24 men) with prior treatment using antimuscarinic agents and/or β3-adrenoceptor agonists were evaluated. Of these, 14 had significant comorbidities, including 8 patients with neurological disorders. Those with neurological involvement received 200 U of onabotulinumtoxinA, whereas the remaining 54 received 100 U (Botox®, Allergan, Irvine, CA, USA). Follow-up assessments at 3, 6, 12 and 24 months included urinary leakage (Pad test), the need for clean intermittent catheterisation (CIC), completion of the OAB questionnaire and monitoring of adverse events.
Results: The treatment resulted in significant reductions in urinary leakage (UL) at 3 and 6 months compared with baseline, along with a marked decrease in detrusor pressure at 6 months (p < 0.05). Both the 100 U and 200 U regimens maintained clinical efficacy for up to one year postprocedure. The incidence of adverse events was comparable to that observed with oral pharmacotherapy.
Conclusions: Intradetrusor BTX-A is a safe and effective therapeutic option for OAB patients who are unresponsive to other therapeutic options. The major benefits observed were lowered detrusor pressure and reduced UL at 6 months, as well as reduced CIC at 6 and 12 months. A 100 U dose appears adequate for most cases, although its benefit tends to diminish after 12 months. Thus, we propose to repeat the procedure after about one year. However, no clinically relevant differences were observed between the 100 U and 200 U doses.
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Background: This study aims to evaluate whether urinating by pulling down the trousers vs. unzipping the trousers only has an effect on maximum flow rate (Qmax), average flow rate (Qave), voiding time and post-void residual urine (PVR) in patients with lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction (BPO).
Methods: Patients receiving alpha-blocker therapy and habitually voiding in a standing position were prospectively enrolled. Each participant underwent uroflowmetry (UF) in two separate sessions, with one session involving voiding by pulling the trousers down to the knees and the other involving voiding by unzipping the trousers only. Qmax, Qave, voiding time and PVR volume were recorded and compared between the two positions.
Results: A total of 74 patients were included in the analysis. The mean Qmax was 10.80 ± 3.20 mL/s in the unzipping position and 13.10 ± 4.04 mL/s in the pulling-down position. The Qave, voiding time and PVR in the unzipping position were 5.01 ± 2.57 mL/s, 70.80 ± 50.40 s and 63.99 ± 38.11 mL, respectively, and those in the pulling-down position were 5.89 ± 3.09 mL/s, 58.20 ± 26.90 s and 53.38 ± 38.96 mL, respectively. Statistically significant differences were observed in Qmax (p < 0.001), Qave (p < 0.001), PVR volume (p < 0.001) and voiding time (p = 0.006).
Conclusions: In patients with LUTS secondary to BPO who void in a standing position, the specific subposition (pulling down trousers vs. unzipping) significantly affects UF parameters and PVR volumes. These findings demonstrate that standing voiding should not be considered as a single, uniform posture. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT06260917; available at https://clinicaltrials.gov/study/NCT 06260917.
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Objective: This study aimed to investigate the association between functional multiparametric magnetic resonance imaging (mpMRI) features and tumour immune microenvironment (TIME) phenotypes (immune-inflamed, immune-excluded and immune-desert) in prostate cancer (PCa) and to develop a multiclass prediction model.
Methods: This retrospective study enrolled 228 patients with PCa who underwent mpMRI between January 2023 and October 2025. The patients were categorised into three TIME phenotypes based on immune cell infiltration patterns. Functional mpMRI features (apparent diffusion coefficient (ADC)_mean, ADC_min, Prostate Imaging Reporting and Data System (PI-RADS) score and lesion diameter) and clinicopathological indices were collected. Variables identified through univariate analysis were entered into a multinomial logistic regression model to assess independent factors associated with TIME phenotypes. Model performance was evaluated through 10-fold cross-validation, receiver operating characteristic (ROC) analysis and confusion matrix evaluation.
Results: Significant differences in prostate-specific antigen (PSA) level, International Society of Urological Pathology (ISUP) grade and mpMRI feature were observed among the three TIME phenotypes (p < 0.05). The immune-inflamed phenotype was associated with higher PSA and lower ADC_mean. The immune-desert phenotype was more common in lesions with low PI-RADS scores. Elevated PSA and reduced ADC_mean were independent factors associated with the immune-inflamed phenotype, whereas a low PI-RADS score was significantly associated with the immune-desert phenotype. ROC analysis showed area under the curve values of 0.654 (95% CI: 0.557–0.691) for immune-inflamed, 0.742 (95% CI: 0.654–0.791) for immune-excluded and 0.802 (95% CI: 0.782–0.852) for immune-desert phenotypes.
Conclusions: Functional mpMRI features show significant associations with TIME phenotypes in PCa. Elevated PSA levels and low ADC_mean value may serve as indicators of the immune-inflamed phenotype, whereas a low PI-RADS score may suggest an immune-desert phenotype. These findings highlight the potential of mpMRI as a non-invasive imaging surrogate for assessing TIME phenotypes and inform precision immunotherapy in PCa.
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Background: The comparative efficacy and safety of minipercutaneous nephrolithotomy (mPCNL) versusstandard percutaneous nephrolithotomy (PCNL) in selected patients with renal stones ≤ 2 cm remain insufficiently defined.
Methods: This retrospective cohort study included 146 adult patients with single renal stones ≤ 2 cm who underwent PCNL between May 2023 and May 2025. The patients were assigned to the mPCNL group (≤ 14 Fr, n = 72) or standard PCNL group (22– 24 Fr, n = 74). All procedures were performed using holmium: Yttrium aluminum garnet (YAG) laser lithotripsy. The primary outcome was the single-session stone-free rate assessed by noncontrast computed tomography (CT) within 3 days postoperatively. Secondary outcomes included perioperative parameters, renal function indices (serum creatinine and cystatin C), inflammatory biomarkers (interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP)) and postoperative complications.
Results: The single-session stone-free rates were comparable between the mPCNL and standard PCNL groups (94.4% vs. 89.2%, p = 0.248). The mPCNL group showed significantly lower intraoperative blood loss, earlier ambulation and shorter hospital stay (all p < 0.001). Although inflammatory markers increased after surgery in both groups, the magnitude of increase in PCT and CRP was significantly lower in the mPCNL group (all p < 0.001). The overall complication rates were low and comparable between the groups (6.94% vs. 12.16%, p = 0.284).
Conclusions: In selected patients with renal stones ≤ 2 cm requiring percutaneous intervention, mPCNL provides similar stone clearance and short-term renal safety compared with standard PCNL whilst offering the advantages of reduced surgical trauma, attenuated postoperative inflammatory response and faster recovery.
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Background: This study aimed to compare the mid- to long-term effects of pirarubicin chemotherapy and Bacillus Calmette– Guérin (BCG) immunotherapy on recurrence control, bladder function and health-related quality of life in patients with nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection of bladder tumour (TURBT).
Methods: This retrospective cohort study comprised 126 patients with NMIBC who underwent TURBT followed by intravesical therapy between January 2018 and December 2023. Patients received either pirarubicin (n = 68) or BCG (n = 58). Propensity score matching was performed to reduce baseline imbalance, yielding 48 matched patients in each group. Recurrence outcomes, recurrence-free survival (RFS), bladder function parameters, quality-of-life scores and adverse events were compared.
Results: After matching, the recurrence rate was lower in the BCG group than in the pirarubicin group (18.75% vs 37.50%, p = 0.041). Time to first recurrence was longer with BCG than with pirarubicin (28.47 ± 8.31 vs 20.96 ± 7.84 months, p = 0.016), and Kaplan–Meier analysis showed improved RFS (median RFS: 45 [34–56] vs 31 [22–40] months; log-rank p = 0.011). At 12 months, the BCG group had lower post-void residual urine volume, higher maximum urinary flow rate, higher European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Core 30 (QLQ-C30) global health and functional scores and lower symptom and Quality of Life Questionnaire-Bladder Cancer Module 30 (QLQ-BLM30) urinary symptom scores than the pirarubicin group (all p < 0.05). Subgroup analysis showed that the benefit of BCG was evident in patients with high-grade tumours. No severe treatment-related adverse events occurred in either group.
Conclusions: In patients with NMIBC after TURBT, intravesical BCG was associated with better recurrence control and more favourable mid- to long-term functional and quality-of-life outcomes than pirarubicin, particularly in high-grade disease.
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Background: Despite their clinical complexity, patients with prostate cancer (PCa) requiring intensive care remain an understudied demographic for which precision prognostic instruments are lacking. We sought to establish and verify a robust nomogram tailored to predict the 28-day mortality risk for this specific cohort.
Methods: We utilised retrospective data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients were randomly assigned to training and validation sets(7:3) by using random seeds. Least Absolute Shrinkage and Selection Operator (LASSO) regression with 20-fold cross-validation and the 1SE rule was employed to select predictors and construct the model. Model performance was evaluated by employing receiver operating characteristic (ROC) curves, calibration plots with Hosmer-Lemeshow tests and decision curve analysis (DCA).
Results: The analysis of 529 patients (370 training/159 validation) yielded six decisive predictors. Our proposed nomogram exhibited markedly higher discriminative accuracy than traditional metrics. Specifically, it achieved an area under the receiver operating characteristic curve (AUROC) of 0.814 in the training set, eclipsing Simplified Acute Physiology Score II (SAPS II) (0.737), Sequential Organ Failure Assessment (SOFA) (0.645) and the Charlson Comorbidity Index (CCI) (0.734). These findings were mirrored in the validation phase (AUROC: 0.809). On the validation set, we also found that the AUROC of our model was 0.809, whereas those of SAPS II, SOFA and CCI were 0.764, 0.686 and 0.725, respectively. High p values in Hosmer-Lemeshow tests (p > 0.05) reflected strong calibration. Meanwhile, DCA curves underscored our nomogram’s superior net clinical benefit over conventional scoring systems.
Conclusions: Our established 28-day mortality prediction model for critically ill patients with PCa facilitates early risk stratification and intervention, potentially improving survival outcomes in this high-risk population.
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Background: This study aimed to investigate the temporal evolution of ultrasound signs in patients with testicular torsion (TT) and correlate these delays with testicular salvageability and long-term reproductive outcomes.
Methods: This retrospective study included 89 patients with TT treated from 2020 to 2025. Based on time from symptom onset to treatment, patients were divided into three groups: hyperacute (<6 hours), subacute (6–12 hours) and delayed (>12 hours). We collected baseline data, ultrasound findings, testicular salvage rates, reproductive hormones levels and semen analysis. We used Spearman correlation and binary logistic regression to analyse the association of ultrasound features, and time windows, with the salvage rate.
Results: The testicular salvage rates of the three groups were 96.8%, 62.1%, and 41.4%, respectively (p < 0.05). Ultrasonographic features evolved with time: the prevalence of heterogeneous parenchymal echo increased while the whirlpool sign decreased (all p < 0.05). The delayed group showed higher follicle stimulating hormone (FSH)/luteinizing hormone (LH) levels and poorer semen quality (p < 0.05). Logistic regression identified a time window <6 hours as an independent protective factor (odds ratio (OR) = 0.036, 95% confidence interval (CI): 0.003–0.473, p = 0.011), whereas uneven testicular echogenicity (OR = 4.451, 95% CI: 1.257–15.763, p = 0.021), a positive whirlpool sign (OR = 4.445, 95% CI: 1.124–17.588, p = 0.033), and absent blood flow (OR = 4.446, 95% CI: 1.091–18.123, p = 0.037) were independent risk factors for salvage failure. The dynamic evolution of ultrasound findings provides an objective risk assessment basis for time sensitive stratified management of acute scrotum, supporting clinical grading and expedited intervention decisions.
Conclusions: The 6-hour threshold may be a critical cutoff for both testicular survival and fertility preservation. For suspected torsion, surgical exploration should be prepared alongside ultrasound to minimize the time to treatment.
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Background: Thisstudy aimed to explore the clinical effect ofstepwise refined nursing in patients who underwent flexible ureteroscopic lithotripsy (FURL) with indwelling ureteral stent placement.
Methods: A retrospective study was conducted. A total of 165 patients who underwent FURL with ureteral stent placement at Huzhou Hospital of Traditional Chinese Medicine from May 2023 to May 2025 were selected. All patients received postoperative treatment with tamsulosin and tolterodine. Amongst them, 83 patients received stepwise refined nursing management (study group), whereas 82 patients received conventional nursing care (control group). Clinical symptoms and pain levels were compared between the two groups.
Results: Postoperative observation showed statistically significant between-group effects for daytime urinary frequency, nighttime urinary frequency, urinary urgency, urge urinary incontinence and total overactive bladder (OAB) symptom score (p < 0.05), indicating that stepwise refined nursing helped alleviate postoperative OAB symptoms. The between-group effects for bodily pain, urinary symptoms, work performance and daily living impact, other problems and total Ureteral Stent Symptom Questionnaire score were statistically significant (p < 0.05), suggesting that stepwise refined nursing contributed to reducing postoperative ureteral stent-related symptoms.
Conclusions: For patients undergoing FURL with indwelling ureteral stents, the application of stepwise refined nursing can effectively reduce the occurrence of postoperative complications, alleviate OAB symptoms and mitigate ureteral stent-related symptoms.
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Objective: This study aimed to compare the clinical efficacy, safety, and patient compliance of transurethral prostatic columnar water balloon dilation versus combination pharmacotherapy (α-blockers + 5α-reductase inhibitors) in patient with moderateto-severe benign prostatic hyperplasia (BPH).
Methods: This retrospective analysis included 120 patient with moderate-to-severe BPH (International Prostate Symptom Score [IPSS] 8–35 points, January 2022–December 2025) After propensity score matching (1:1), patient were divided into a surgical group (n = 60, transurethral prostatic columnar water balloon dilation) and a medication group (n = 60, combined pharmacotherapy). Key outcomes assessed at baseline and 1, 3, and 6 months post-treatment included IPSS, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), prostate volume (PV), quality of life (QoL), adverse events (AEs), compliance, and satisfaction.
Results: At all follow-up points, both groups showed significant improvements in IPSS, QoL, PVR, and voiding time (p < 0.05). At 6 months, outcomes were significant better in the surgical group than in the medication group: total IPSS (8.32 ± 2.34 vs. 14.22 ± 2.57), Qmax (20.59 ± 3.51 vs. 14.54 ± 3.51 mL/s), and PVR (29.58 ± 9.67 vs. 45.92 ± 12.51 mL) (all p < 0.05). PV decreased significantly in the medication group (52.13 ± 8.56 vs. 67.60 ± 10.12 mL, p < 0.05) but did not change significantly in the surgical group (p > 0.05). The surgical group had a lower unadjusted AE rate (6.7% vs. 20.0%, p = 0.032), but a higher standardized short-term procedural event rate. Complete compliance (95.0% vs. 68.3%, p < 0.001), and satisfaction (89.42 ± 6.83 vs. 73.62 ± 8.59, p < 0.001) were also higher in the surgical group.
Conclusions: For moderate-to-severe BPH, transurethral prostatic columnar water balloon dilation provides superior short-tomedium-term efficacy, safety, and compliance compared with pharmacotherapy, making it particularly suitable for high-risk or medication-intolerant patients.
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Background: To investigate fibrosis-related gene expression profiles in benign ureteral strictures and their association with restenosis after ureteroplasty and to develop a predictive risk score model.
Methods: A total of 100 patients with benign strictures who underwent ureteroplasty were included. Stenotic tissues were collected intraoperatively, and the expression levels of 15 fibrosis-related genes were determined by quantitative real-time PCR. According to whether restenosis occurred at 12 months postoperatively, the patients were assigned to stenotic group (n = 39) and non-stenotic group (n = 61). Independent predictors were identified using logistic regression, a risk score model was constructed and model performance was assessed using receiver operating characteristic curve, calibration curves and decision curve analysis (DCA). The restenosis-free rates of the risk groups were compared through Kaplan–Meier survival analysis, and internal validation was performed through Bootstrap resampling.
Results: High expression levels of type I collagen α1 chain (COL1A1), transforming growth factor-β1 (TGFB1), Snail family member 1 (SNAI1), SMAD family member 3 (SMAD3) and thrombospondin 2 (THBS2) genes were identified as independent risk factors for postoperative restenosis (all p < 0.05). Kaplan–Meier analysis revealed that the restenosis-free rate at 12 months was significantly lower in the high-risk group than in the low-risk group (51.02% vs. 70.59%, log-rank p = 0.007). The area under the curve (AUC) of the risk scoring model was 0.854 [95% confidence interval (CI): 0.772–0.973], with a sensitivity of 87.12% and specificity of 84.55%. Bootstrap internal validation yielded a corrected AUC of 0.848 (95% CI: 0.812–0.891), confirming the model’s stability. The calibration curve demonstrated good agreement between predicted probabilities and observed outcomes (Hosmer–Lemeshow test, p > 0.05). DCA showed that the model provided a net clinical benefit across a wide range of threshold probabilities. Further analysis showed that the expression levels of the above five genes were significantly positively correlated with the pathological fibrosis grade of stenotic tissues (all p < 0.001).
Conclusions: The high expression levels of COL1A1, TGFB1, SNAI1, SMAD3 and THBS2 in benign ureteral strictures is closely related to the degree of tissue fibrosis and postoperative restenosis. The risk scoring model based on these genes showed good predictive performance and can thus serve as useful tool for clinical individualised treatment and prognostic assessment.
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Objective: Urosepsis is a severe and critical condition in urology. This retrospective study aimed to evaluate the effectiveness of a DeepSeek-based case-based learning (DS-CBL) method in educating nursing students about emergency management for urosepsis.
Methods: This study included nursing students from the spring semester of 2024 (March–July 2024). The students’ relevant learning materials were retrospectively analysed, and they were divided into a DS-CBL group and a control group (traditional case-based learning (CBL)) in accordance with the teaching methods they received. Both groups systematically learned emergency management for urosepsis. Academic performance, Student Evaluation of Educational Quality (SEEQ), Creative SelfEfficacy (CSE) scale, Utrecht Work Engagement Scale-Student (UWES-S) and learning satisfaction were evaluated before and after the learning period.
Results: A total of 112 nursing students from the vocational college were included in this study: 57 in the DS-CBL group and 55 in the control group. No statistically significant difference was found in the general information between the two groups (p > 0.05). The DS-CBL and traditional CBL teaching methods improved students’ test scores for emergency management of urosepsis, but the DS-CBL group’s scores were higher (p < 0.05). After systematic instruction, the SEEQ, CSE and UWES-S scores increased in both groups, with the DS-CBL group showing significantly higher scores (p < 0.05). Neither group reported severe dissatisfaction with the course, but the DS-CBL group had higher satisfaction (p < 0.05).
Conclusions: Compared with traditional teaching methods, the DS-CBL teaching method may be beneficial for improving students’ mastery of knowledge related to emergency management of urosepsis, indicating potential for promotion.
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Aims: This study aimed to evaluate the diagnostic value of real-time shear wave elastography (SWE) combined with magnetic resonance imaging-ultrasound (MRI-US) cognitive fusion targeted biopsy in repeat prostate biopsy.
Methods: The retrospective cohort study comprised 120 patients who underwent transperineal repeat biopsy. Group A (n = 64) had standard cognitive fusion targeted biopsy plus systematic biopsy; Group B (n = 56) had additional real-time SWE before cognitive fusion to refine targeting. The primary endpoint of the study was the clinically significant prostate cancer (csPCa), which was based on targeted cores. Secondary endpoints encompassed the following: overall PCa detection, core-specific cancer detection rate, agreement with final pathology, diagnostic performance, and complications.
Results: It is evident from the data that Group B had a significantly higher csPCa detection rate in comparison to Group A (p < 0.05). The number of biopsy cores was comparable, yet the core-specific cancer detection rate was higher in Group B (p < 0.05). In Group B, maximum elastic modulus of shear wave elastography (SWE-Emax) values and the proportion of the Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions were significantly higher in csPCa lesions than in benign lesions (p < 0.001). Group B had superior sensitivity, specificity, accuracy, and agreement with final pathology. Receiver operating characteristic (ROC) curve analysis suggested that the combination of SWE-Emax with PI-RADS score yielded a higher diagnostic performance than either individual method (area under the curve (AUC) = 0.904, 95% confidence interval (CI): 0.825–0.983, p < 0.001). Subsequent analysis revealed no significant disparities in complication rates between the two groups (p > 0.05).
Conclusions: The combination of real-time SWE and MRI-US cognitive fusion targeted biopsy has been shown to be associated with a higher detection rate of clinically significant prostate cancer and improved biopsy accuracy during repeat biopsies, offering incremental diagnostic value without additional risks.
Case Report
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Background: Gastrointestinal-origin urinary foreign bodies are rare and often overlooked, particularly because early Computed Tomography (CT) scans may be inconclusive, especially in cases involving wooden materials.
Case Presentation: A 19-year-old man presented with lower-abdominal pain and gross hematuria one week after accidentally ingesting a toothpick. Initial local CT scans were negative. At our center, bedside ultrasonography revealed a linear hyperechoic tract crossing the bladder wall, while thin-slice non-contrast CT only detected a punctate hyperdensity at the bladder dome. Cystoscopy confirmed the presence of a wooden toothpick partially penetrating the bladder; ureteroscopic extraction successfully removed the intact 6-cm toothpick, followed by an uneventful recovery.
Conclusions: A detailed ingestion history along with thin-slice non-contrast CT and high-frequency ultrasonography can help identify subtle wooden foreign bodies. These diagnostic tools should prompt early cystoscopy, and selective gastrointestinal endoscopy is warranted when suspicion remains high. Endoscopic removal is preferred, with escalation reserved for cases of complex extraluminal migration.
