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Background: Benign prostatic hyperplasia (BPH) is a condition prevalent in men over 50 years old and characterised by benign prostatic obstruction and lower urinary tract symptoms. The RezumTM system, a minimally invasive technique based on thermal ablation using water vapor, aims to provide an effective treatment with reduced surgical effect and preserved quality of life.
Methods: A bibliographic review was conducted on publications indexed in PUBMED and SCOPUS from 2015 to 2023. Sixteen studies, including clinical trials and multicentre experiences, on the adverse effects (AEs) and tolerance to RezumTM treatment were selected. Data were organised in accordance with Clavien–Dindo criteria and compared with bipolar transurethral resection of the prostate (TURP).
Results: The main AEs associated with RezumTM include haematuria (1.7%–71.7%), dysuria (1.79%–64.5%), frequency/urgency (3.2%–50%), acute urinary retention (4.4%–33.8%) and urinary tract infection (2%–20%). These events are generally mild to moderate (Clavien–Dindo I–II) and tend to resolve spontaneously or with symptomatic treatment. Erectile dysfunction was reported in less than 5.56% of all reviewed studies, highlighting its limited impact on sexual function. Re-treatment rates were within the range of 4.4%–8.33%, associated with the conservative therapeutic strategy.
Conclusions: The RezumTM system demonstrates a favourable safety profile with mild/moderate and manageable AEs and high tolerability (100% across reviewed studies). It is an effective and minimally invasive alternative for managing BPH, particularly for patients seeking to minimise surgical risk and preserve sexual function.
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Background: Radical prostatectomy is a common treatment option for patients with prostate cancer (PCa). In patients with a high-risk disease, the association of pelvic lymphadenectomy is recommended. This review aimed to address the main aspects of performing pelvic lymphadenectomy, including extension and anatomical aspects, number of lymph nodes (LNs) dissected, staging and presurgical planning, nomograms, benefits, and complications, in patients with high-risk PCa.
Methods: We conducted a narrative review using English articles from the MEDLINE/PubMed database. The articles were selected because of their high level of evidence and importance, and we utilized the following expressions and combinations of terms: “high-risk prostate cancer”, “pelvic lymph node dissection”, “lymphadenectomy” and “radical prostatectomy”.
Results: LN involvement in patients with PCa is an independent risk factor for poor prognosis, and this procedure increases the risk of perioperative morbidity. Extended pelvic LN dissection is indicated in high-risk patients, and nomograms are useful in determining whether LN dissection should be performed because of the risk of LN involvement. Determining whether the rate of complications increases during the procedure is important.
Conclusions: In high-risk PCa, extended pelvic LN dissection promotes local staging better than that achieved through limited pelvic LN dissection and new imaging methods at the expense of increased risk of complications.
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In primary hyperoxaluria (PH), clinical manifestations can initiate during early childhood. Given the high prevalence of urinary lithiasis and chronic kidney disease (CKD) among adult population, in which clinical manifestations of PH after childhood, diagnosis becomes more difficult. This guide was developed to improve the diagnostic and therapeutic fields of PH in adult patients for clinicians. PH can cause (i) kidney stones and (ii) calcium oxalate crystal deposition within the kidney tissue (oxalate nephropathy). Clinical criteria for suspected PH in adults include the following: (i) Recurrent stone disease (in children, however, it should be suspected in the first episode); (ii) Nephrocalcinosis that is particularly associated with decreased glomerular filtration rate (GFR); (iii) Presence of oxalate crystals (calcium oxalate monohydrate and whewellite) in any biological fluid or tissue. To the above, the following can be added: (iv) Hyperoxaluria without clear cause of secondary hyperoxaluria; (v) Oxalate urinary excretion >1.0 mmol/1.73 m2 body surface area in two samples; (vi) Kidney transplant recipients with previous CKD of unknown aetiology or previous history of recurrent urolithiasis and presenting graft nephrocalcinosis and GFR drop with no other clear cause. Routine PH screening of all adult patients with hyperoxaluria is costly strategy and therefore not recommended. Suspected PH in adults should be guided in accordance with clinical criteria. In patients with a confirmed PH diagnosis, all efforts should be directed towards adequate genetic and biochemical characterisation given that each patient can benefit from various therapeutic strategies.
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Recent advances in paediatric vesicoureteral reflux (VUR) have focused on risk-stratification models to better identify patients at risk for complications such as renal scarring, persistent VUR, or breakthrough urinary tract infections (UTIs). By addressing critical clinical questions-such as predicting VUR presence, assessing the likelihood of spontaneous resolution, and determining the risk of breakthrough UTIs despite antibiotic prophylaxis-these tools enhance decision-making. Predictive models like the VURx score and ureteral diameter ratio integrate clinical, demographic, and imaging data to provide personalised risk assessments. Additionally, machine-learning techniques have advanced predictive accuracy by analysing complex interactions among risk factors, enabling tailored treatment plans. These stratification methods help clinicians minimise unnecessary procedures whilst ensuring early intervention for high-risk patients. In terms of management, continuous antibiotic prophylaxis (CAP) remains a common strategy for preventing UTIs in children with VUR. Guidelines from the American Urological Association (AUA) and European Society for Paediatric Urology (ESPU) emphasise a risk-based approach, recommending CAP primarily for high-risk patients. Alternatives to CAP include behavioural interventions, such as managing constipation and encouraging regular voiding, to reduce UTI recurrence. They should be considered as the initial step for all patients with suspected VUR. For patients with persistent reflux or recurrent UTIs despite conservative measures, surgical options, including endoscopic injection or ureteral reimplantation, offer effective solutions to mitigate long-term complications.
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Background: Robotic surgery has made significant technological advances, with robotic single-port surgery emerging as an innovative approach. However, this technique requires a reassessment of surgical training because its learning curve (LC) may differ from that of standard robotic procedures. In this comprehensive review, the LC of single-port and standard robotic surgeries in different urological procedures is evaluated and compared.
Methods: A non-systematic review of robotic surgeries and LCs was performed in September 2024 using relevant articles from PubMed, Scopus and the Cochrane Central Register of Controlled Trials. The review focused on the LCs and structured programmes for robotic procedures. Articles were selected based on their relevance to urological practice and the availability of objective or subjective metrics for assessing the LC. Studies describing institutional protocols, simulation training and modular curricula were also included.
Results: Robotic radical prostatectomy, cystectomy, kidney transplantation, nephrectomy (radical and partial), pyeloplasty and single-port procedures were evaluated in relation to the LCs and structured programmes. Key findings highlight significant variability in LC duration depending on the procedure, surgeon’s experience, and type of robotic platform.
Conclusions: Future research should aim to standardise LC metrics, capture surgeons’ baseline experiences and explore innovative training methods, such as simulation-based learning, to ensure the safe and efficient mastery of robotic urological surgery. Collaborative efforts between academic centres and robotic training platforms may facilitate more consistent and reproducible surgical education pathways.
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Purpose: This study aimed to evaluate perioperative outcomes and postoperative complications following minimally invasive radical cystectomy with ileal conduit (RCIC) performed under an enhanced recovery after surgery (ERAS) protocol, using the Clavien-Dindo classification (CDC) and the comprehensive complication index (CCI).
Methods: An ambispective study (2018–2022) was conducted, collecting demographic, perioperative and postoperative data, with a focus on complications among patients treated during and outside the COVID-19 period. Results were compared between surgeries conducted during the COVID-19 pandemic, including the first wave, and those performed in a non-COVID period.
Results: Among these 90 patients, 49 underwent surgery during the complete COVID-19 period, compared with 41 patients in the pre- and post-pandemic control period. Additionally, 15 of the cases occurred during the first wave of the pandemic. The COVID-19 group showed a higher rate of pN0 staging (87.8% vs 67.5%, p = 0.021) and fewer pN1 cases (2% vs 20%, p = 0.005) than the control group. The most common complications were genitourinary (71, 78.9%), infectious (59, 65.6%) and gastrointestinal (54, 60%). Median CCI increased significantly with each ascending CDC (r = 0.934, p < 0.001). Notably, 20.3% of patients in CDC ≤3a were reclassified to severe morbidity (CCI ≥33.7), with elevated rates during COVID-19 periods (46.7% and 42.9% vs 34.1%). CCI showed a more consistent correlation with length of stay than CDC (r = 0.551, p < 0.001 vs r = 0.460, p < 0.001).
Conclusions: Minimally invasive RCIC during the COVID-19 pandemic was associated with increased postoperative morbidity. Compared with RCIC, the CCI provides a more accurate estimation of morbidity burden and should be incorporated into standard surgical outcome reporting.
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Background: Alpha blockers (ARBs) are important agents in treating benign prostatic hyperplasia (BPH). Although multiple ARBs are available, comparative data on their early and mid-term effects are limited. This study aimed to evaluate and compare the early clinical efficacy of three ARBs (alfuzosin, tamsulosin and silodosin) in patients with lower urinary tract symptoms due to BPH.
Methods: This retrospective study was conducted using a 1:1:1 matched design on the basis of age, prostate-specific antigen level and prostate volume. Eligible patients were subsequently grouped for comparison. Patients received 10 mg of alfuzosin, 0.4 mg of tamsulosin or 8 mg of silodosin once daily for 3 months. Uroflowmetry parameters, including maximum urinary flow rate (Qmax), average urinary flow rate (Qave) and post-void residual volume (PVR), were assessed at baseline, 6 h after the first dose and at the first and third months. The International Prostate Symptom Score (IPSS) and quality of life (QoL) scores were evaluated at baseline and the first and third months. Repeated-measure analysis of variance (ANOVA) and Bonferroni post-hoc tests were applied.
Results: A total of 117 patients were included in the final analysis, with 38 in the alfuzosin group, 40 in the tamsulosin group and 39 in the silodosin group. Repeated-measure ANOVA revealed that all groups showed significant improvements over time in Qmax, IPSS and QoL scores (p < 0.001). Silodosin provided a significantly greater increase in Qmax at 6 h than alfuzosin (p = 0.013) and tamsulosin (p = 0.044), though no statistically significant differences were observed between groups at the first or third month (p = 1.000). PVR values decreased in all groups over time, but intergroup differences were not statistically significant (p > 0.05).
Conclusions: Silodosin provided the most rapid symptomatic improvement following initial administration, likely due to its high α1A-receptor selectivity. However, by the third month, all three agents showed similar clinical efficacy, supporting their use as viable treatment options tailored to patient-specific needs.
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Aim: Apelin is a regulatory peptide that exerts its effects through the G protein-coupled APJ receptor (APJ-R), expressed across various organs. Studies on apelin in the male reproductive system remain limited. Adenomyomatous hyperplasia (AH) and related lower urinary tract symptoms become more prevalent with age. Similar to other sex organs, the prostate is highly responsive to hormones and growth factors. Dihydrotestosterone influences apoptosis and proliferation through intracellular androgen receptors, whereas 5α reductase inhibitors serve therapeutic and haemostatic purposes. This study aims to determine whether Apelin exerts differential effects on apoptosis and angiogenesis in the prostate tissues of AH and treated AH cases.
Material and Methods: Cases diagnosed with adenomyomatous hyperplasia through prostatectomy and/or prostate transurethral resection (TUR) material between 2011 and 2013, either treated with (treatment-G) or without 5α-reduction inhibitor therapy (Adeno-G group), were included in the study. In addition, cases diagnosed in 2023 with benign prostate tissue via tru-cut biopsy (Benign-G) were incorporated. Paraffin-embedded tissue blocks from these cases were stained immunohistochemically using apelin antibody and evaluated under a light microscope.
Results: The study included 132 cases, comprising 69 in the Benign-G group, 33 in the treatment-G group and 30 in the Adeno-G group. Staining results for all tissues (epithelial and stromal) revealed a significant difference in positive/negative ratios amongst the groups (p = 0.006). The Benign and Adeno groups exhibited similar positive/negative distributions (37.0% vs. 63.0% and 33.3% vs. 66.7%, respectively), whereas negative staining predominated in the treatment group (84.8%).
Conclusions: The significant decrease in apelin levels in the treatment group, along with the apparent relationship between 5dihydrotestosterone (HT) levels and apelin, suggests a potential broader relevance beyond benign cases.
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Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been popular surgical treatment approaches for peritoneal carcinomatosis over the past three decades. In addition to metastases due to intra-abdominal malignancies, retroperitoneal renal metastases may occur. This study aimed to evaluate the safety and feasibility of performing nephrectomy in selected patients who underwent CRS for peritoneal carcinomatosis, without increasing morbidity and mortality, and to determine its effect on overall survival (OS).
Methods: In this single-centre retrospective observational study, 11 cases that required partial/total nephrectomy were reviewed amongst patients who underwent CRS and HIPEC for peritoneal carcinomatosis between 2017 and 2024. The effects of the surgical procedure on postoperative OS, mortality and morbidity were evaluated.
Results: The average age of the patients was 54 years (range: 23–83 years). Peritoneal carcinomatosis was caused by colon carcinoma in four cases, sarcomatosis in two cases, renal cell cancer in two cases, ovarian carcinoma in one case, mesothelioma in one case and teratomatosis in one case. Right nephrectomy was performed in six cases, right partial nephrectomy in three cases, left nephrectomy in one case and bilateral nephrectomy in one case. The average Peritoneal Cancer Index was 22.2, and complete cytoreduction was achieved in 90.9% of the patients. No 30-day mortality was observed. The average OS was 14 months (range: 2–53 months). The 1-year survival rate was 45.4%, the 2-year survival rate was 18% and the 3-year survival rate was 9%.
Conclusions: In cases of peritoneal carcinomatosis that require nephrectomy, CRS combined with HIPEC can be performed to achieve complete cytoreduction without increasing morbidity and mortality.
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Background: Ureteroscopic lithotripsy for renal or ureteral stones is a standard technique performed by every urologist. Double J (DJ) stents are a part of this surgery. This study investigated how patients’ compliance affects the time of DJ stent removal.
Methods: The cases of patients aged 20–80 years old who underwent transurethral ureteroscopic lithotripsy were reviewed. The duration of postoperative DJ stent retention was set as 21–28 days in all cases, and a duration of 14–35 days indicated compliance. Short durations signified intolerance, and long durations were considered negligence. The age, gender, stone side, level and size, and educational level and behaviours regarding stent removal of the patients were compared.
Results: A total of 146 patients were included. The duration of DJ stent retention ranged from two days to 152 days (mean 36.6 days). Amongst the patients, 66 were compliant with the recommended removal time of 28 ± 7 days, whereas 80 were noncompliant. The mean age of the group unable to tolerate stents was significantly lower (p = 0.032) that those of other groups. When the patients were divided into two groups on the basis of educational level (low and high), a significant relationship was observed between compliance with stent removal timing and educational level (p = 0.036).
Conclusions: Postoperative planning is critical for young patients. This study demonstrated that a significant number of patients are unaware of the timing for DJ stent removal. Educational status, in particular, should be taken into consideration. Various measures, such as mobile phone applications, reminder short message service (SMS) messages and record-keeping systems, can help prevent complications caused by forgotten stents.
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Background: This study aims to investigate the potential use of qualitative interferon-γ release assay, specifically T-spot testing focusing on culture filtrate protein 10 (CFP-10) positivity, in predicting the response of patients with high-risk non-muscle invasive bladder cancer (NMIBC) to intracavitary Bacillus Calmette-Guerin (BCG) vaccine instillation.
Methods: Patients diagnosed with high-risk NMIBC were retrospectively identified from an institutional database and subsequently underwent prospective T-spot testing. Following the completion of an adequate course of BCG instillation, patients who were unresponsive to BCG were assigned to the study group. By contrast, those who remained recurrence free for at least one year post-treatment were assigned to the control group.
Results: In this cohort of 42 patients with high-risk NMIBC, the median age was 67, and 40.0% were unresponsive to BCG. The distribution comprised 50.0% pTa and 81% high-grade cases. Over a median follow-up of 18 months, the positive BCG response varied between pTa (81%) and pT1 (38%; p = 0.005), and T-spot testing revealed positivity in 75.0% of the control group and 92% in BCG-unresponsive patients (p = 0.235). Notably, CFP-10 positivity was significantly more prevalent in the BCG-unresponsive group, observed in 91.7% of the patients, in contrast to 35.7% in the control group (p = 0.004).
Conclusions: T-spot test or more specifically CFP-10 positivity is a potential marker for predicting response to BCG instillation in patients with NMIBC.
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Background: Fragile patients with indwelling bladder catheter (IBC) represent a category at high risk of morbidity and overall quality of life decline. The goal for these patients is to remove the bladder catheter and avoid surgical stress, complications and long hospitalisation. Prostatic artery embolisation (PAE) has been developed as a minimally invasive procedure for the treatment of benign prostatic obstruction (BPO)-related lower urinary tract symptoms. We evaluated the results of PAE in patients unfit for surgery with IBC.
Methods: We retrospectively reviewed data on fragile patients unfit for surgery due to comorbidities with IBC secondary to BPO who underwent PAE in three centres. Our objective was to remove urinary catheter and maintain patients free from bladder catheter. We divided patients into two groups: Those with successful (Group A) or unsuccessful (Group B) procedure after 1 year.
Results: A total of 74 patients with IBC receiving PAE were included. No PAE failure occurred due to tortuous or atherosclerotic vessels. After 1 year, 49 patients (66.20%) were without bladder catheter. We found no differences in age (75.30 vs 78.70), Charlson comorbidity index (6.00 vs 6.60), prostate volume (94.70 vs 94.70), hospital stay (1.90 vs 3.90 days), catheterisation time after the procedure (17.20 vs 20.80 days) or complication rate (11.20% vs 8.30%) between Groups A and B. One patient developed postembolisation partial penile necrosis, two had penile skin ischemia (conservatively managed), and four developed urinary tract infection following the procedure. The history of IBC was longer in Group B than in Group A (9.70 vs 6.20 months, p = 0.018). Multivariate logistic regression confirmed a significant reduction in the probability of unsuccessful procedure based on an increased postoperative catheterisation time (odds ratio = 0.91; 95% confidence interval: 0.83–0.99).
Conclusions: PAE is a minimally invasive surgical treatment for BPO. This procedure should be considered in elderly and fragile patients, based on its favourable safety profile. In our series, PAE was a safe procedure for patients with IBC affected by BPO. In our experience, the success of this treatment is correlated with postoperative catheterisation. Patient’s selection and counselling are key for optimising the results.
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Background: The study aimed to analyse the comparative effect of low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet-rich plasma (PRP), and their combination for treating arteriogenic erectile dysfunction (ED).
Methods: This prospective observational study involved men diagnosed with arteriogenic ED over six months. Four hundred men aged 35–65 with ED, diagnosed using the International Index of Erectile Function (IIEF-5) and penile colour Doppler ultrasonography (USG), joined the research. The participants were divided into four groups: Li-ESWT, PRP, Li-ESWT + PRP, and Control. Outcomes were assessed at baseline and at one, three and six months post-treatment, focusing on changes in IIEF-5 scores and penile haemodynamics, including peak systolic velocity (PSV) and end-diastolic velocity (EDV).
Results: Li-ESWT significantly improved IIEF-5 scores from baseline to three months (p = 0.001), with sustained but reduced effects at six months (p = 0.001). PRP alone showed mild improvement at one month (p = 0.028), with no significant effect persisting at six months (p = 0.119). Combination therapy demonstrated the most pronounced and sustained improvement in IIEF-5 scores, particularly at three and six months (p = 0.001). Haemodynamic analysis revealed a significant increase in PSV at three months in the Li-ESWT and combination groups (p = 0.001) with mild regression at six months (p = 0.003). EDV changes were negligible across all groups and time points (p > 0.05).
Conclusions: Combining Li-ESWT and PRP provided the most substantial and sustained improvement in erectile function and arterial haemodynamics. While Li-ESWT demonstrated notable efficacy, PRP alone showed limited and transient benefits.
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Background: Erectile dysfunction (ED) and sarcopenia share common risk factors, particularly advanced age. This study aimed to assess the effect of sarcopenia on ED treatment outcomes.
Materials and Methods: A prospective observational study was conducted, involving patients receiving ED treatment from six different centres. Sarcopenia was evaluated using the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) questionnaire, the 30-Second Chair Stand Test, and the 4-Meter Walk Test. The International Index of Erectile Function (IIEF) questionnaire was used to assess ED severity. The treatment response in patients regularly using phosphodiesterase type 5 inhibitors (PDE5i) for ED was analysed in relation to sarcopenia.
Results: The study included 137 patients (mean age = 54.91 ± 12.46 years) who regularly used PDE5i. Sarcopenia suspicion was present in 15.33% (n = 21) of patients. Those with suspected sarcopenia were older (mean age = 64.62 ± 5.83 years) and had lower baseline IIEF scores (8.76 ± 3.57) than patients without suspected sarcopenia (p < 0.001 for both). Whilst the IIEF scores significantly increased after PDE5i treatment in patients without suspected sarcopenia (from 11.64 ± 4.82 to 17.28 ± 5.70; p < 0.001), the increase was not significant in those with suspected sarcopenia (from 8.76 ± 3.57 to 9.81 ± 5.14; p = 0.283).
Conclusions: Sarcopenia may contribute to a poor response to ED treatment, particularly in older patients. It could be a significant factor in ED treatment resistance, especially at an advanced age.
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Background: We aimed to determine which parameters other than the time until torsion surgery can predict orchiectomy risk in acute testicular torsion (TT).
Methods: The medical records of acute TT who applied to five different health centres in Turkey between 2016 and 2023 were analysed retrospectively. Patients who underwent orchiectomy because blood flow cannot be detected were defined as Group I, and patients with testicles preserved and fixed were defined as Group II. The differences between the two groups and potential predictors of testicular salvage were analysed.
Results: Eighty-three patients with TT were included in the study. Amongst them, 44 (53.01%) were included in Group I and 39 patients (46.99%) in Group II. Time from the onset of pain to surgery and mean platelet volume (MPV) were significantly higher in Group I (p < 0.05). In Group II, the ipsilateral Prehn’s sign negativity rates, the rate of normal ipsilateral testicular echogenicity, and the rate of normal volume on ultrasonography were significantly higher than those in Group I (p < 0.05). We created a new scoring system named Time, MPV, Prehn’s sign, Echogenicity, and Volume (TMPEV) that can predict the risk of orchiectomy in TT by using the parameters that differed statistically between Groups I and II.
Conclusions: The time until surgery may not be the only factor affecting the possibility of testicular recovery in acute TT. MPV, positivity of Prehn’s sign, differentiations in ipsilateral testicular echogenicity and volume changes on ultrasonography, may have significant value in predicting the possibility of orchiectomy after open detorsion surgery. If more comprehensive and clear nomograms similar to our new TMPEV scoring system can be created, more proactive algorithms can also be developed for predicting orchiectomy after TT and managing TT.
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Objective: This study aimed to explore the effect of electroacupuncture (EA) stimulation on bladder function improvement, sleep quality and psychological state in patients with neurogenic bladder (NB) after spinal cord injury (SCI).
Methods: Patients with NB after SCI treated in our hospital from January 2020 to January 2025 were retrospectively enrolled and divided into a traditional treatment group and an EA treatment group on the basis of their treatment protocols. Both groups received bladder function training, with the EA group additionally receiving EA. Bladder function was evaluated using maximum bladder capacity (MBC), intravesical pressure (IVP) and residual urine volume (RUV). Micturition frequency (MF), single voided volume (SVV) and maximum voided volume (MVV) were used to assess micturition status. The Pittsburgh Sleep Quality Index (PSQI), the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS) were used to evaluate sleep quality and psychological state.
Results: A total of 118 patients were included (56 in the EA group and 62 in the traditional group). The EA group showed significantly better improvements in bladder function and micturition indices (MBC, RUV, MF, SVV and MVV) than the traditional group (p < 0.05). The PSQI, SAS and SDS scores in the EA group were notably lower, indicating marked improvements in sleep quality and psychological state (p < 0.05). The EA group also had a lower incidence of adverse reactions (p < 0.05).
Conclusions: EA stimulation combined with bladder function training effectively improves bladder function, micturition, sleep quality and psychological state in patients with NB after SCI.
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Purpose: This study aimed to assess the efficacy and safety of same-day flexible ureteroscopic lithotripsy (FURL) and compare clinical outcomes between different ureteral access sheaths.
Methods: A retrospective review was conducted on 182 patients who underwent FURL at our day surgery centre between March and December 2024. The patients were grouped according to the type of ureteral access sheath used: Suction group (navigable suction sheath) and convention group (conventional ureteral sheath). Perioperative outcomes, including operative time, stone-free rate, postoperative parameters and accessory device usage, were compared between the groups.
Results: All the patients successfully completed FURL and were discharged on the same day. The mean stone size was 13.93 ± 6.49 mm, and the mean operative time was 36.70 ± 15.69 min. The overall stone-free rate was 89.56% (163/182). The average postoperative haemoglobin drop was 12.17 ± 7.40 g/L, with a mean procalcitonin level of 0.04 ± 0.02 ng/mL. The pain score prior to discharge was 0.39 ± 0.76, and the mean length of stay was 10.41 ± 2.10 h. The suction group demonstrated significantly reduced use of stone retrieval baskets compared with the convention group. No significant differences in operative time or complication rates were observed.
Conclusions: Same-day FURL is safe and effective in appropriately selected patients. The navigable suction ureteral access sheath offers a clinically advantageous alternative by reducing accessory device use without compromising surgical outcomes.
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Background: Cancer stem cells (CSCs) contribute to bladder cancer (BCa) progression and treatment resistance. Ferroptosis, an iron-dependent cell death, influences CSC maintenance, but its post-translational regulation remains unclear. This study investigated how the deubiquitinase OTUB1 regulated ferroptosis and CSC-like traits in BCa through interaction with SLC7A11.
Methods: OTUB1 expression was assessed in clinical BCa tissue pairs (tumour vs adjacent normal) collected from patients undergoing surgical resection and in cell lines. Gain- and loss-of-function models were established in BCa cells. Cell viability, stemness capacity and ferroptosis markers were evaluated using Cell Counting Kit-8 (CCK-8) assay, Western blot, sphere formation assay, quantitative real-time polymerase chain reaction (qRT-PCR), immunofluorescence, reactive oxygen species (ROS) detection, enzyme-linked immunosorbent assay (ELISA) and co-immunoprecipitation.
Results: OTUB1 was significantly upregulated in BCa cells and tissues relative to normal controls (p < 0.01). OTUB1 overexpression significantly enhanced BCa cell viability, self-renewal capacity and stemness marker expression but reduced ferroptosisassociated indicators (ROS, malondialdehyde (MDA) and ferrous iron (Fe2+)) (p < 0.01). Conversely, OTUB1 knockdown impaired stem-like traits (p < 0.01) and triggered ferroptosis (p < 0.01). Mechanistically, OTUB1 directly interacted with SLC7A11, decreased its ubiquitination and stabilised its protein expression (p < 0.01). Notably, ectopic SLC7A11 expression rescued the impaired stemness and ferroptosis induction caused by OTUB1 knockdown (p < 0.01).
Conclusions: OTUB1 inhibits ferroptosis and sustains CSC-like features in BCa by deubiquitinating and stabilising SLC7A11. The OTUB1-SLC7A11 axis represents a novel regulatory mechanism of CSC maintenance and may serve as an intervention point in BCa.
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Background: Epithelial cells (ECs) are key drivers of prostate cancer (PCa) initiation and progression. Our study aimed to identify EC-related immune genes as prognostic biomarkers and explore their clinical significance to guide therapy.
Methods: Single-cell RNA sequencing data from prostate adenocarcinoma samples were analysed to identify EC-specific markers. Prognosis-related immune genes were screened using univariate Cox regression analysis, and a predictive gene signature model was established by employing least absolute shrinkage and selection operator regression analysis. Kaplan–Meier survival analysis and receiver operating characteristic (ROC) curves were used to assess the performance of the gene signature model. Immunohistochemical staining of clinical specimens was conducted to validate key findings.
Results: A five-gene prognostic signature (opioid receptor κ1 (OPRK1), early growth response 1 (EGR1), arrestin β2 (ARRB2), high mobility group box 2 (HMGB2), and tripartite motif-containing 27 (TRIM27)) model was derived from the differential expression profiles of EC-associated immune genes in PCa. Patients with PCa placed in the high-risk group exhibited significantly poorer survival outcomes. Our prognostic gene signature model demonstrated strong predictive accuracy and clinical applicability. Patients in the high-risk group showed a higher infiltration of regulatory T cells (Tregs) and M2 macrophages, whereas resting memory cluster of differentiation 4 (CD4+) T cells were more abundant in the low-risk group. Among the signature genes, OPRK1 was markedly overexpressed in PCa tumour tissues, and its expression was positively associated with a favourable prognosis.
Conclusions: This study highlights the prognostic value of EC-derived immune genes in PCa and establishes a reliable gene signature model for PCa risk stratification. Notably, OPRK1 may serve as a novel therapeutic target, offering new insights into precision oncology and improving outcome prediction for patients with PCa.
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Introduction: Emerging studies have indicated that obstructive sleep apnea (OSA) is an independent risk factor for erectile dysfunction (ED). However, the results are inconsistent. By leveraging aggregated statistical data from genome-wide association studies (GWAS), we performed a bidirectional mendelian randomization (MR) analysis to further investigate the potential causal link between OSA and ED.
Materials and Methods: We chose single nucleotide polymorphisms (SNPs) as instrumental variables based on rigorous criteria. Our research adopted five advanced two-sample MR analysis approaches, specifically encompassing inverse-variance weighting (IVW), MR-Egger, weighted median, simple mode, and weighted mode. Additionally, we conducted several sensitivity analyses to evaluate heterogeneity, horizontal pleiotropy, and stability, including Cochrane’s Q test, MR-Egger intercept test, MR-pleiotropy residual sum and outlier (MR-PRESSO) global test, and leave-one-out analysis.
Results: The study included one dataset related to ED (Bovijn et al.) and two datasets related to OSA (Finngen and Sakaue et al.). The MR study results using the IVW method showed no significant causal association between OSA and ED in two datasets related to OSA. (IVW, odds ratio (OR): 1.01, 95% confidence interval (CI): 0.82–1.24, p = 0.954; 1.07, 0.87–1.30, p = 0.532, respectively). The results of other four MR analysis methods were consistent with IVW. In the reverse MR analyses, there was no causal effect of ED on OSA according to IVW method (IVW, OR: 1.01, 95% CI: 0.96 to 1.06, p = 0.708; 0.95, 0.87–1.05, p = 0.319, respectively). Moreover, sensitivity analysis showed that the study results remain highly consistent, with no indication of multi-collinearity or heterogeneity.
Conclusions: Our MR analysis revealed no clear bidirectional causal link between OSA and ED.
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Background: While enzalutamide has demonstrated reliable therapeutic efficacy in the management of prostate cancer (PC), a substantial proportion of patients eventually develop resistance to this medication after prolonged therapy. Despite this, the identification of biomarkers to effectively predict clinical outcomes in PC patients who exhibit resistance to enzalutamide remains uncertain. The aim of this study was to identify a specific gene associated with acquired resistance to enzalutamide in PC and to investigate the potential prognostic value of this gene.
Methods: The GSE183100, GSE147541, and GSE16560 datasets were obtained from the Gene Expression Omnibus database. Differential gene expression analysis was conducted using the DESeq2 R package and Wilcoxon’s rank-sum test. Subsequently, biological process enrichment analysis and gene set variation analysis were performed to identify a promising candidate gene. Additionally, the correlation between the proportions of immune cell infiltration and the expression of candidate genes was evaluated. Finally, the potential implications of these candidate genes on survival outcomes were investigated.
Results: A comprehensive analysis identified a total of 975 differentially expressed genes, predominantly involved in biological processes related to angiogenesis, inflammatory response, positive regulation of cell division, and membrane potential. Notably, secreted frizzled-related protein 1 (SFRP1) expression demonstrated strong, favorable correlations with both angiogenesis and the infiltration of Regulatory T cells. Moreover, the overexpression of SFRP1 was found to be closely associated with improved prognosis in patients with PC.
Conclusions: In conclusion, the downregulation of SFRP1 in enzalutamide-resistance PC is associated with angiogenesis and cellular infiltration. This study identified SFRP1 as a diagnostic biomarker for patients with PC who have developed acquired enzalutamide resistance. These findings provide an important theoretical foundation for the development of novel and complementary therapeutic approaches for PC management.
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Background: Pulmonary embolism (PE) secondary to lymphocyst formation after robotic-assisted laparoscopic radical prostatectomy (RALRP) is a rare but serious complication. Although most patients with pelvic lymphocysts receive effective conservative treatment, there is no consensus on treatment strategies for patients who do not respond to conservative treatment. This case report highlights the clinical features, diagnostic challenges, and treatment approaches for managing this condition.
Case Presentation: A 61-year-old male with prostate cancer (pT3N0M0) underwent RALRP. One week after discharge, he developed swelling and pain in his right lower limb, with localised warmth and worsening symptoms upon activity. A pelvic lymphocyst was suspected and the patient was initially managed symptomatically prior to discharge. However, three weeks later, he returned with persistent right lower limb edema and new-onset dyspnea. Further evaluation confirmed a secondary PE due to the lymphocyst. The patient showed significant improvement after a comprehensive treatment strategy, including anticoagulation, thrombolysis, and inferior vena cava filter placement. Concurrently, the lymphocyst was successfully managed with computed tomography (CT)-guided percutaneous drainage and sclerotherapy, leading to complete resolution. The patient was discharged without complications, and follow-up showed no recurrence.
Conclusions: PE secondary to lymphocyst formation is an uncommon but serious complication after radical prostatectomy. Early detection and intervention in high-risk patients are essential to improve patient outcomes.
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Background: Shrinking, soft glans penis is contemporarily unavoidable in patients with penile implantation, the final solution to intractable erectile dysfunction (ED). This condition poses a challenge in primary impotence.
Case Presentation: We present a case of a 43-year-old patient with primary impotence who underwent six penile prosthesis procedures, alternating between inflatable and malleable prostheses. His sixth implantation involving a malleable cylinder enabled him to engage in dozens of intercourse episodes between the ages of 42 and 43 years. However, this action led to an impending prosthesis extrusion. The patient reported that his partner had firstly raised concerns regarding his shrinking, soft glans. Although prosthesis extrusion is avoidable and soft glans is treatable, persistent surgeon ignorance has led to missed management opportunities. Anatomical understanding is crucial for surgical success. Therefore, we present this unusual case to highlight strategies for treating soft glans in patients with penile implantation.
Conclusions: Although the proactive implementation of preventive measures against prosthesis extrusion was firstly recommended 3 decades ago and a novel strategy for glans enhancement was introduced a decade ago, inadvertent ignorance persists in modern surgical practice. In this case study, we highlight the importance of proper cylinder positioning and the need for innovative glans enhancement techniques.
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