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The first description of focal therapy (FT) for prostate cancer was by Gary Onik when he described the use of hemigland cryoablation. Currently, focal therapy is performed using different energy modalities: (1) Cryotherapy, (2) irreversible electroporation, (3) high-intensity focused ultrasound, (4) transurethral ultrasound ablation, (5) focal laser therapy, (6) bipolar radiofrequency ablation and (7) photodynamic therapy. Intermediate-risk prostate cancer with an index lesion seen on prostate magnetic resonance imaging, with negative or low-grade cancer on systematic biopsies is appropriate candidate for focal therapy. Currently, most follow-up protocols include prostate-specific antigen (PSA) measurement every three months during the first year and every six months thereafter, conducting multiparametric magnetic resonance imaging (mpMRI) scans at six months, twelve months, and then annually, as well as performing targeted biopsies of the ablation zone along with systematic biopsies between six to twelve months post-treatment. In general, FT rarely results in significant morbidity and appears to have a minimal effect on quality of life, however long-term oncological outcomes require further assessment. The heterogeneity in technologies, patient selection criteria, follow-up protocols and lack of high-level evidence for focal therapy present the biggest challenges in recommending this treatment modality as a standard management option for selecting patients. The aim of this article is to discuss the challenges surrounding patient selection and to review the different focal therapy modalities and follow-up strategies after treatment.
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Background: In this study, biomarkers that can predict prostate cancer with a Gleason grade of 8 or higher were explored through nuclear magnetic resonance (NMR).
Methods: Patients scheduled for transrectal prostate biopsy were enrolled, and urine samples were collected after prostate massage. Patients with cancer were categorised as having Gleason grades of 6–7 or ≥8. All spectra were acquired using a Bruker Avance III DRX 600 spectrometer. For statistical analysis, univariate and multivariate analyses were conducted using metabolites and clinical variables, and the presence of tumours with Gleason grades of ≥8 was predicted.
Results: Data were obtained from 107 patients with prostate cancer: 73 (68.2%) with Gleason grades of 6–7 and 34 (31.8%) with Gleason grades of ≥8. A predictive model incorporating the 29 most significant metabolites identified through partial least squares-discriminant analysis was established. Suspicious digital rectal examination (DRE) results were considered. The model predicted a Gleason grade of ≥8, demonstrating an area under the curve of 0.92, sensitivity of 82%, specificity of 92%, positive predictive value of 84% and negative predictive value of 90%. Metabolites associated with amino acid metabolism and glycolysis were prominent in this model.
Conclusions: Our study demonstrates that a model combining urinary metabolites with clinical data, specifically DRE findings, can effectively stratify risk in patients with biopsy-confirmed prostate cancer according to Gleason grade. Metabolites linked to glycolysis and amino acid metabolism were particularly relevant. This minimally invasive approach may assist clinical decision-making, although validation in larger multi-centre cohorts is required to confirm its robustness and generalisability.
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Background: Testicular torsion (TT) is a critical condition caused by spermatic cord twisting, which can result in irreversible testicular damage without timely intervention. In Chile, centralised healthcare and significant geographic barriers can delay treatment for TT, which potentially worsens outcomes. This study evaluates the impact of referral status on orchiectomy rates among paediatric TT cases treated at two hospitals in Southern Chile.
Methods: A cross-sectional analysis was conducted on TT cases in patients under 15 years. These patients were treated at Hospital Guillermo Grant Benavente and Hospital Las Higueras between January 2018 and January 2024. Data on demographics, symptom duration, referral status and treatment timelines were analysed using Wilcoxon rank-sum and Pearson’s Chi-squared tests, with significance set at p < 0.05.
Results: Among 144 patients, 71% were referred from other facilities. Orchiectomy was performed in 44 cases, with a median symptom duration of 48 h, which was significantly longer than that of non-orchiectomy cases (5 h, p < 0.001). Referred patients showed a higher crude orchiectomy rate (35% vs. 20%; p = 0.064). However, in the multivariable analysis with adjusted age, hospital and symptom onset time, referral emerged as an independent predictor of orchiectomy (odds ratio (OR) = 3.68; 95% confidence interval (CI): 1.15–13.1; p = 0.035).
Conclusions: Referral delays in TT management correlate with increased orchiectomy rates. Enhancing specialist access and referral protocols is crucial to reducing treatment delays and improving outcomes in regions with dispersed healthcare services.
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Background: The body image perception (BIP) of patients may deteriorate after surgery. Our study aims to evaluate the BIP of patients who underwent retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) because of kidney stones.
Methods: A total of 158 patients, including 46 patients who underwent PCNL, 57 patients who underwent RIRS and 55 patients in a healthy control group, were included in this prospective study. The BIP of patients was evaluated by using the Body Dysmorphic Disorder Scale (BDDS) questionnaire. BDDS was administered to patients during the preoperative period and in the first and third postoperative months. The BDDS scores of patients were compared amongst the PCNL, RIRS and control groups. One-way analysis of variance (ANOVA) was employed to compare the means of variables across the three patient groups.
Results: The mean BDDS score in the PCNL group (n = 46) was significantly higher than that in the RIRS (n = 57) and control groups (n = 55) in the first postoperative month (p = 0.008 and 0.008). No significant difference was found between the mean BDDS scores of patients in the RIRS and control groups in the first postoperative month (p = 1.000). No significant difference was found amongst the mean BDDS scores of patients in the PCNL, RIRS and control groups in the third postoperative month (p = 0.725). A positive correlation was found between the educational levels and BDDS scores of patients (p = 0.000, r = 0.529), whereas a negative correlation was found between age and BDDS score (p = 0.030, r = –0.320).
Conclusions: No deterioration in BIP was found in patients who underwent RIRS. In patients who underwent PCNL, negative BIP was observed in the first postoperative month and improved by the third postoperative month, reaching levels similar to those in the control and RIRS groups. RIRS and PCNL are reliable surgical methods in terms of postoperative BIP.
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Objective: To evaluate the efficacy of supervised and early use of the Epi-No® device in preventing urinary incontinence (UI) and perineal injury six months post-delivery in primigravid women.
Methods: A quasi-experimental matched study was carried out in a low-risk obstetric unit hospital. Gravid women in the study group (SG) underwent 10 sessions (twice weekly for five weeks) using the Epi-No® device from the 34th gestational week onwards. SG was valued prior to the intervention (between the 30th and 32nd gestational weeks) and six months post-delivery. UI was measured using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF).
Results: Thirty-seven participants were included in the SG, conversely 32 participants in the control group (CG) were included in the analysis. The SG demonstrated a higher number of participants with intact perineum or first-degree laceration only, compared with the CG (p < 0.001). Women in the CG had a 9.86% greater likelihood of experiencing second- or third-degree perineal lacerations or undergoing episiotomy, whereas those in the SG had a 96.70% lower likelihood of deep laceration (p < 0.001). In addition, the SG exhibited a significantly greater maximum perineal strength than the CG (p = 0.004). A significant inverse correlation (–0.38) was observed between perineal strength and ICIQ-UI SF score in the SG (p = 0.001).
Conclusions: Assisted use of the Epi-No® device from 34 weeks of pregnancy correlated with less severe deep perineal injuries, better quality of life, and significantly reduced postpartum ICIQ-UI SF scores.
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Background: Human papillomavirus (HPV) is a prevalent viral infection that poses considerable health risks to males, including genital warts and various cancers. The epidemiology of HPV in the male population requires novel approaches for effective patient education. This study investigated the efficacy of Chat Generative Pre-trained Transformer-4 (ChatGPT-4), a sophisticated artificial intelligence model, in disseminating accurate information about HPV-induced genital warts in men.
Methods: A meticulously designed questionnaire comprising 240 items, spanning multiple-choice and true/false formats, was administered to ChatGPT-4 from October 2024 to January 2025. The questionnaire covered HPV transmission, clinical manifestations, diagnostic approaches, treatment options and preventive strategies. The responses were evaluated for accuracy and completeness using Likert scales, with repeated questioning sessions to assess the potential for response improvement over time.
Results: ChatGPT-4 initially provided accurate and/or highly rated responses for 191 out of 240 questions. Subsequent rounds of questioning for inaccurately answered or low-scoring questions showed a progressive improvement, with 14 and 15 questions answered correctly or receiving higher accuracy scores in the second and third rounds, respectively. The overall accuracy rate was 79.60%, with specific subgroup analyses revealing strengths in general information and protection but challenges in questions about HPV-induced genital warts in men.
Conclusions: ChatGPT-4 demonstrates preliminary medical value and potential for patient education in urology. However, variable subgroup accuracy suggests that further optimisation and validation are needed before clinical deployment. Its ability to accurately address a wide range of queries, combined with the potential for an improvement in response accuracy over time, highlights its value in enhancing health communication.
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Aim: This study aimed to assess the relationship between serum adropin levels and the severity of erectile dysfunction (ED) and to investigate serum adropin levels as a potential biomarker of ED severity.
Material and Methods: This prospective case-control study was conducted amongst patients who applied to our outpatient clinic. Patients’ medical histories were obtained, and comprehensive systemic examinations were conducted. Fasting glucose levels, lipid profiles, total testosterone levels, adropin levels and International Index of Erectile Function (IIEF) scores were measured and analysed through logistic regression and receiver-operating characteristic curve analysis.
Results: Of the 89 patients, 45 complained of ED and matched with 44 patients without ED. Adropin levels were significantly lower in the ED group (p = 0.001; p < 0.05). Using a cut-off value of 2.1 for adropin, the sensitivity was 91.11%, and the specificity was 45.45% with a positive predictive value of 63.08%, negative predictive value of 83.33% and accuracy of 68.54%. The area under curve was 0.711. Logistic regression analysis revealed that adropin values below 2.1 were associated with a 6.31-fold increased risk of developing ED. Furthermore, a significant relationship was observed between serum adropin levels and IIEF scores.
Conclusions: Adropin levels below 2.1 may serve as an independent risk factor of developing ED. This finding may contribute to the development of possible predictive models for individualising andrological patient management.
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Background: Cisplatin (CP) is an effective chemotherapeutic agent. However, its clinical application is limited by its notable gonadotoxic and systemic side effects. Apilarnil, a biologically active product of drone larva, possesses antioxidant, anti-inflammatory and androgenic properties, which suggests its potential protective effects against chemotherapy-induced toxicity. This study aimed to investigate the protective and therapeutic effects of different doses of apilarnil on CP-induced gonadal toxicity and systemic biochemical changes in a rat model.
Methods: A total of 64 adult male Wistar rats were randomly assigned to eight experimental groups, including the control, CP-treated, apilarnil-treated (50 and 100 mg/kg) and combined CP-apilarnil treatment groups. Treatments were administered via orogastric gavage or intraperitoneal injection. Testicular and epididymal weights, epididymal sperm concentration and motility, haematological and biochemical parameters and histopathological changes were evaluated.
Results: CP administration considerably decreased testis and epididymis weights, sperm concentration and motility while altering haematological indices (mean corpuscular volume, lymphocytes and neutrophils), elevating serum glucose, triglycerides, cholesterol, liver enzyme levels and reducing testosterone levels. Apilarnil treatment, particularly when administered prior to CP exposure, ameliorated these adverse effects by improving sperm parameters, normalising blood indices, modulating biochemical markers and enhancing histological preservation of seminiferous tubules.
Conclusions: Apilarnil exhibits promising protective effects against CP-induced gonadal toxicity and systemic damage. These findings support further investigation of apilarnil as an adjunctive agent to mitigate chemotherapy-associated side effects.
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Background: This study aimed to compare the efficacy and safety of prone and supine percutaneous nephrolithotomy (PCNL) in patients with complex renal stones and anatomical abnormalities.
Methods: This retrospective study analysed the data of patients with complex renal stones and anatomical anomalies who underwent PCNL between December 2022 and June 2024. Inclusion criteria encompassed adult patients with complex renal stones (Guy’s score 3 or 4), staghorn calculi, diverticular stone, obesity, kyphoscoliosis and solitary kidney or renal anomalies (horseshoe kidney, autosomal dominance polycystic kidney, malrotated kidney, and pelvic kidney). Patients were divided into prone (group P) and supine (group S) groups on the basis of PCNL positioning. Efficiency was evaluated on the basis of stone-free rates (SFRs), and safety was assessed using the Clavien-Dindo complication classification.
Results: A total of 222 patients were included in the study, with 118 patients in group P and 104 patients in group S. No significant differences were observed in stone burden, Hounsfield unit (HU) density or other demographic parameters. Group S had a shorter operative time (105.78 ± 15.71 min) and time to positioning (14.83 ± 12.44 min, p < 0.001) but a longer scopy time (8.13 ± 2.88 min, p < 0.001). The overall SFRs were 77.11% for group P and 75.00% for group S (p = 0.713). Postoperative complications, assessed using the Clavien-Dindo classification, were similar between the groups, with 4.23% major complications in group P and 5.76% in group S.
Conclusions: Supine and prone PCNL demonstrated similar success rates and complication profiles, with supine PCNL offering the advantage of shorter operative times while effectively managing complex cases.
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Background: Adrenocortical carcinoma (ACC) is a rare and fatal adrenal cortex cancer with a poor prognosis and high mortality rate. Although surgical resection is the primary treatment for ACC, recurrence is still common. p21-activated kinase 4 (PAK4) is linked to tumour development and progression, being overexpressed in various cancers. However, the role of PAK4 in ACC remains unclear.
Methods: In this study, PAK4 expression in ACC was analysed using sequencing data from the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases, assessing its clinical relevance with Kaplan–Meier, Cox regression, receiver operating characteristic (ROC) curve and prognostic nomogram models. Functional enrichment of PAK4-related genes was explored using protein-protein interaction (PPI) networks, Gene Ontology (GO)/Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene set enrichment analysis (GSEA). The association between PAK4 messenger RNA (mRNA) expression and immune infiltration was examined via Tumor Immune System Interaction Database (TISIDB). Finally, immunohistochemistry was used for tissue validation.
Results: In the GEO and TCGA databases, PAK4 expression was significantly higher in ACC tissues than in normal samples (p < 0.05). High PAK4 levels were associated with poor prognosis, including shorter overall survival, disease-specific survival and progression-free interval (p < 0.05). Elevated PAK4 expression correlated with advanced T, N and M stages (p < 0.05), indicating increased malignancy in ACC. A PPI network predicted associations between PAK4 and its targets, whereas GSEA linked PAK4 to the Hedgehog signalling pathway and cell proliferation (p < 0.05). The upregulation of PAK4 was also connected to immune regulation and tumour-infiltrating immune cells such as T cells, B cells and mast cells (p < 0.05). Immunohistochemistry confirmed high PAK4 expression in ACC (p < 0.001).
Conclusions: PAK4 is significantly overexpressed in ACC, and it may play a carcinogenic role, showing great application potential as a potential therapeutic target and an independent prognostic biomarker of ACC.
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Background: Haemorrhoidectomy, although an important intervention for the management of haemorrhoids, is associated with a risk of postoperative urinary retention in some patients, impacting prognosis and quality of life. This single-centre retrospective study evaluates the efficacy of acupoint moxibustion in the management of post-haemorrhoidectomy urinary retention.
Methods: Patients who developed urinary retention following haemorrhoidectomy were enrolled and allocated into either a traditional hot compress treatment group or an acupoint moxibustion combined treatment group, according to their postoperative management. The traditional hot compress group received hot compress therapy alone, whereas the combined group received additional moxibustion at Qihai (CV6), Guanyuan (CV4) and Shenque (CV8) acupoints alongside conventional hot compress therapy. Baseline clinical characteristics, improvement in urinary retention and duration of postoperative indwelling catheterisation were compared between the groups. Changes in pelvic floor muscle strength, severity of lower abdominal pain, incidence of adverse reactions and patient comfort (assessed by the General Comfort Questionnaire (GCQ)) were also evaluated.
Results: At one and two weeks post-treatment, the combined treatment group demonstrated a higher overall efficacy rate in improving urinary retention, shorter duration of postoperative indwelling catheterisation, greater recovery of pelvic floor muscle strength, more substantial reductions in Visual Analogue Scale (VAS) pain scores and significantly higher GCQ scores (all p values < 0.05) compared with the traditional hot compress group. Both groups showed improvements in pelvic floor muscle strength, reductions in VAS scores and increases in GCQ scores at one and two weeks post-treatment relative to baseline. The incidence of adverse reactions was 6.00% (3/50) in the traditional group and 2.00% (1/50) in the combined group, with no statistically significant difference (p > 0.05).
Conclusions: Acupoint moxibustion combined with traditional hot compress therapy appears to be an effective and safe approach for managing post-haemorrhoidectomy urinary retention. It significantly improves urinary function, reduces the duration of catheterisation, enhances pelvic floor muscle recovery, alleviates lower abdominal pain and increases patient satisfaction and comfort, with a favourable safety profile.
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Background: Retrograde intrarenal surgery (RIRS) is minimally invasive with rapid recovery, whereas tamsulosin hydrochloride promotes stone expulsion and reduces pain. Whether their combination has a synergistic effect on treating renal calculi ≤2 cm remains unclear. This study aims to explore the efficacy and safety of RIRS combined with tamsulosin in such patients using single-centre data.
Methods: The clinical data of patients with renal calculi ≤2 cm treated in The First Hospital of Fangshan District, China from January 2021 to January 2024 were retrospectively collected. The patients were divided into a combination therapy group (RIRS + oral tamsulosin) and a control group (RIRS alone). Clinical efficacy, stone-free rate and adverse event incidence were compared between the groups. Renal function changes, pain intensity and quality of life before and after treatment were evaluated.
Results: After propensity score matching, 53 patients were included in the combination therapy group and 53 in the control group. The total effective rate in the combination therapy group was 96.22% (51/53), which was higher than that (81.13%, 43/53) in the control group (χ2 = 6.014, p = 0.014). The stone-free rate in the combination therapy group was also significantly higher than that in the control group (94.34% vs. 79.25%, χ2 = 5.267, p = 0.022), whereas the scores of expulsive pain, first stone expulsion time and complete stone expulsion time were significantly lower (t = 2.165, 7.142, 4.538; All p < 0.05). After treatment, the levels of serum creatinine, blood urea nitrogen, uric acid, β2-microglobulin, interleukin-6, tumour necrosis factor-α and C-reactive protein decreased in both groups. The glomerular filtration rate and scores of physical function, psychological status, social function and symptoms/discomfort improved. The enhancements in the combination therapy group were more significant than those in the control group (all p < 0.05). No difference in the incidence of postoperative complications was found between the two groups (13.21% vs. 11.32%, χ2 = 0.088, p = 0.767).
Conclusions: RIRS combined with tamsulosin demonstrates remarkable short-term clinical efficacy, stone clearance and renal function protection in patients with renal calculi ≤2 cm, showing promising clinical application.
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Objective: This study aims to evaluate the predictive utility of multi-slice spiral computed tomography (MSCT) in assessing the response to neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC).
Methods: The clinical data of patients with MIBC who received treatment at our institution between January 2022 and January 2024 were retrospectively analysed. The patients were assigned to an observation group or a control group according to whether pathological downstaging was achieved following NAC with a gemcitabine and cisplatin regimen. A multivariate logistic regression analysis was conducted to develop a clinical prediction model, and a receiver operating characteristic (ROC) curve was generated to assess its diagnostic performance. For the evaluation of the model’s stability, all patients were randomly assigned to either a training set or a validation set in a 7:3 ratio.
Results: A total of 86 patients were included in the study, among whom 46 achieved pathological downstaging with a downstaging rate of 53.49%. Multivariate logistic regression analysis identified blood flow (BF; odds ratio (OR), 95% confidence interval (CI): 0.63 (0.48–0.81)) and blood volume (BV; OR, 95% CI: 0.04 (0.00–0.46)) measured by MSCT as independent predictors of NAC efficacy (p < 0.05). In the training set, the area under the ROC curve (AUC) was 0.94 (95% CI: 0.89–0.99), with a specificity of 0.86 and a sensitivity of 0.87. In the validation set, the AUC was 0.98 (95% CI: 0.93–1.00), with a specificity of 0.84 and a sensitivity of 0.88. The Hosmer–Lemeshow goodness-of-fit test indicated good calibration, with p-values of 0.504 and 0.915 in the training and validation sets, respectively. The calibration curve demonstrated strong concordance with the ideal 45° reference line, indicating close alignment between predicted and observed probabilities. Decision curve analysis further confirmed the clinical utility of the nomogram, showing a favourable net benefit across a wide range of threshold probabilities.
Conclusions: Pre-chemotherapy BF and BV parameters measured by MSCT were identified as significant predictors of NAC efficacy in patients with MIBC. The predictive model constructed using these parameters demonstrated strong performance in forecasting pathological downstaging following NAC.
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Background: Prostate adenocarcinoma (PRAD) is the most prevalent malignancy in men and frequently evades early detection. However, the role of genes containing adenylate uridylate- (AU-) rich elements (AREGs) in PRAD remains largely uncharacterized.
Methods: Publicly available PRAD datasets were analyzed through weighted gene co-expression network analysis (WGCNA) to identify co-expressed gene modules. Unsupervised clustering defined AREG-associated molecular subtypes. Prognostic genes were selected via univariate/multivariate Cox proportional hazards regression (Cox) regression and least absolute shrinkage and selection operator (LASSO) regularization. Tumor immune infiltration was profiled using CIBERSORT and other bioinformatic tools, with functional enrichment revealing associated mechanisms. Single-cell transcriptomics (TISCH2) and drug sensitivity predictions (CellMiner) were integrated. Finally, quantitative reverse transcription polymerase chain reaction (qRT-PCR) validated hub gene expression in PRAD.
Results: We identified three AU-rich element-related prognostic genes: ACSM3, ACTG2, and DES. The low-risk group exhibited enhanced immune pathway activity and elevated tumor-infiltrating immune cell levels compared to high-risk patients. Functional analyses linked high-risk scores to pathways such as glycosylation and proteasome regulation. Single-cell transcriptomics revealed widespread expression of ACSM3, while ACTG2 and DES were fibroblast-enriched. Drug sensitivity predictions suggested Docetaxel as a potential therapeutic agent for high-risk PRAD patients.
Conclusions: In this study, we propose that an AREG-based signature comprising ACSM3, ACTG2, and DES effectively predicts prognosis and reflects immune microenvironment characteristics in PRAD. Through systematic analysis, we established a prognostic model utilizing these three AREGs, which demonstrates strong potential as a clinical predictor for PRAD patient outcomes.
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Objective: To evaluate the therapeutic effect of low-intensity pulsed ultrasound (LIPUS) on erectile dysfunction (ED), follow up on its continued effects, and analyze the effects of age, body mass index (BMI), smoking, drinking, diabetes, and hypertension on it.
Methods: A retrospective analysis was conducted on patients with ED who initially received LIPUS treatment at our hospital between October 2020 and October 2021. The patients’ ED was evaluated according to the International Index of Erectile Function (IIEF-EF) and Erection Hardness Score (EHS), and the included patients were statistically analyzed to uncover the treatment efficacy, continued effects, and factors influencing the therapeutic efficacy of LIPUS.
Results: Among 56 patients with ED, the IIEF-EF and EHS scores before LIPUS treatment were 9.61 ± 6.41 and 1.24 ± 0.99 points, respectively. At 6.41 ± 4.14 months after LIPUS treatment, the IIEF-EF and EHS scores improved to 16.00 ± 7.88 and 2.29 ± 1.12 points, respectively, both showing significant improvement (p < 0.05). Of the included patients, 21 were followed for up to 12.57 ± 3.10 months after their initial treatment, with no observed reduction in the therapeutic effect of LIPUS (p > 0.05). Binary logistic analysis revealed that none of the factors of interest, including age, obesity/overweight, smoking, drinking, diabetes, and hypertension, had a significant impact on the therapeutic effect of LIPUS (p > 0.05).
Conclusions: LIPUS demonstrated a good therapeutic effect on ED, with no significant decrease in efficacy after about 12 months of follow-up and without variations attributable to age, obesity/overweight, smoking, drinking, diabetes, or hypertension.
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Background: This study aimed to evaluate the diagnostic value of serum matrix metalloproteinase-9 (MMP-9) and nuclear matrix protein 22 (NMP22) in patients with bladder cancer.
Methods: Patients pathologically diagnosed with bladder cancer between January 2023 and January 2024 were included as the experimental group, while healthy individuals undergoing routine physical examinations during the same period comprised the control group. Serum MMP-9 and NMP22 levels were measured via enzyme-linked immunosorbent assay. Diagnostic performance was assessed using receiver operating characteristic curves, and multivariate logistic regression was performed to determine their ability to independently predict tumor-node-metastasis (TNM) stage.
Results: Serum MMP-9 and NMP22 levels were significantly higher in bladder cancer patients compared to healthy controls (p < 0.001). Patients at the T stage showed significantly elevated levels compared to those at the N and M stages (p < 0.001). The areas under the curves for MMP-9, NMP22, and their combination were 0.786 (95% confidence interval (CI): 0.714–0.857), 0.785 (95% CI: 0.714–0.857), and 0.793 (95% CI: 0.725–0.862), respectively, with corresponding sensitivities of 70.00%, 72.00%, and 75.00%, and specificities of 80.00%, 78.00%, and 85.00%. Hematuria (odds ratio (OR): 3.42, 95% CI: 1.89–6.18), frequent urination (OR: 2.44, 95% CI: 1.41–4.22), urinary urgency (OR: 2.18, 95% CI: 1.19–3.99), MMP-9 (OR: 1.01, 95% CI: 1.004–1.016), and NMP22 (OR: 0.98, 95% CI: 0.97–0.99) were identified as independent predictors of TNM stage (p < 0.05). The Cancer Genome Atlas (TCGA) data further confirmed elevated MMP-9 messenger RNA (mRNA) expression in tumor tissues versus adjacent normal tissues (p < 0.001).
Conclusions: Serum MMP-9 and NMP22 levels are significantly elevated in bladder cancer and correlate with TNM stage. Combined detection may improve diagnostic accuracy and clinical utility in bladder cancer diagnosis.
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Objective: By analyzing penile measurement values, this study explored the changes in the degree of penile concealment in infants under 12 months of age, to reflect whether surgical treatment is necessary.
Methods: The flaccid penile length, stretched penile length (SPL), and penile index (PI) were measured at birth and 12 months of age. Paired t-tests were conducted to compare the PI differences in infants in the concealed penis group at birth and 12 months, with p < 0.05 considered statistically significant. An independent samples t-test was used to compare the SPL differences between the two groups at birth and 12 months, with p < 0.05 indicating statistical significance.
Results: A total of 161 newborns born between August 2019 and June 2023 were divided into two groups: The concealed penis (n = 81) and the normal infant group (n = 80). The PI of infants in the concealed penis group at 12 months was 0.38; When compared to the initial PI of 0.35 at birth, the difference was not statistically significant. At 12 months, the SPL for the normal infant group was 2.59 cm, slightly longer than the SPL of 2.48 cm in the concealed penis group; However, the difference was not statistically significant.
Conclusions: In infants with a concealed penis, the concealed state does not significantly worsen during birth to 12 months, nor does it notably impact penile development. Surgical intervention may therefore be deferred for patients under 12 months of age for further observation.
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Background: Patients undergoing intravesical chemotherapy following transurethral resection of bladder tumour (TURBT) frequently face challenges including insufficient disease-related knowledge, inadequate self-management skills during chemotherapy intervals and discontinuity in routine postoperative care. This study aimed to investigate the effects of continuity of care patterns on cancer-related fatigue, self-care ability, fear of recurrence and risk of complications.
Methods: This retrospective study included 105 patients who received intravesical chemotherapy after TURBT in our hospital between January 2022 and December 2024. The patients were divided into a study group (receiving continuity of care, n = 44) and a control group (not receiving continuity of care, n = 61) according to whether they received continuity of care. Their baseline characteristics and clinical data were retrospectively analysed, and their Piper Fatigue Scale-Revised (PFS-R), Exercise of Self-Care Agency Scale (ESCA) and Fear of Cancer Recurrence Inventory Scale (FCRI) scores were collected before and 6 months after intervention.
Results: After the intervention, the behavioural fatigue, emotional fatigue and somatosensory fatigue dimension scores and PFSR total points of the study group were significantly lower than those of the control group (p < 0.05). The scores in the dimensions of sense of responsibility, self-concept, self-care skills and health knowledge level and ESCA total points of the study group were significantly higher than those of the control group (p < 0.05). The severity, coping strategies, psychological distress, insight, reassurance dimension scores and FCRI total points of the study group were significantly lower than those of the control group (p < 0.05). During the follow-up period, the incidence of urinary tract infection (UTI) and urethral pain in the study group was significantly lower than that in the control group (p < 0.05).
Conclusions: Continuity of care was associated with reduced cancer-related fatigue, improved self-care ability, low fear of recurrence and few complications such as UTI and urethral pain in patients receiving intravesical chemotherapy after TURBT. This study describes an evidence-based care protocol designed to improve transitional healthcare management for this patient population.
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Objective: This study aimed to determine whether asperuloside (ASP) inhibits the proliferation and invasion of bladder cancer (BLCA) cells and its ability to undergo epithelial-mesenchymal transition (EMT) by downregulating activating transcription factor 6 (ATF6) signalling.
Methods: The expression levels of ATF6 and EMT markers were assessed in tumor and surrounding normal tissues obtained from patients with BLCA. In vitro, T24 BLCA cells were transfected with the ATF6 plasmid or a control vector, treated with different concentrations of ASP (0, 1, 3 and 5 mM) and then treated with 5 mM ASP. We examined cell growth, apoptosis (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) assay), migration and invasion (Transwell), EMT markers (E-cadherin, N-cadherin and Snail) and inflammatory cytokines (interleukin-6 (IL-6), C-C motif ligand 2 (CCL2) and C-X-C motif chemokine ligand 10 (CXCL10)) using Western blot, quantitative real-time polymerase chain reaction (qRT-PCR) and functional assays.
Results: BLCA tissues had significantly higher levels of ATF6 than nearby normal tissues (p < 0.01). ASP treatment decreased cell invasion and migration in a dose-dependent manner (p < 0.05) and markedly increased apoptosis in T24 cells (p < 0.05). E-cadherin was upregulated and N-cadherin and Snail proteins were downregulated (p < 0.05) as a result of changes in the expression of EMT markers. In addition, ASP decreased inflammatory cytokine levels of IL-6, CCL2 and CXCL10 messenger RNA (mRNA) (p < 0.01 vs. control). ATF6 overexpression partially counteracted these effects, confirming ATF6’s function in mediating ASP’s biological effects.
Conclusions: In T24 BLCA cells, ASP inhibits ATF6, which prevents apoptosis resistance and migration and alters the expression of inflammatory genes and EMT markers. According to these findings, ASP is a promising natural substance that targets the endoplasmic reticulum (ER) stress-ATF6 axis in BLCA. It has a unique multi-target capability that allows it to simultaneously control inflammation, tumour proliferation and metastasis, providing a therapeutic advantage over conventional single-target agents.
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Objective: This study aimed to investigate the pathogen distribution and drug resistance of sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors in patients with urinary tract infection (UTI) during the treatment of type 2 diabetes mellitus (T2DM).
Methods: A retrospective study was conducted to collect clinical data from patients with T2DM who developed UTI during treatment with SGLT-2 inhibitors. Patients were admitted to the West China Tianfu hospital, Sichuan University between December 2023 and February 2025. Urine samples were used to analyse the distribution of pathogenic bacteria and antibiotic resistance rates.
Results: A total of 233 patients, including 71 males (30.47%) and 162 females (69.53%), who met the inclusion and exclusion criteria were admitted. Sixty-one strains (26.18%) of Gram-positive bacteria and 167 strains (71.67%) of Gram-negative bacteria were detected. Five cases (2.15%) of fungi (Candida albicans) were recorded. The top two Gram-positive bacteria were Enterococcus faecalis (E. faecalis) (34.43%) and Enterococcus faecium (E. faecium) (22.95%), and the top two Gram-negative bacteria were Escherichia coli (E. coli) (79.04%) and Klebsiella pneumoniae (K. pneumoniae) (11.38%). Different pathogens were resistant to different types of antibiotics. The resistance rates of E. faecium to penicillin, gentamicin, ciprofloxacin, clindamycin, erythromycin and cotrimoxazole were significantly different from those of E. faecalis (p < 0.05). The resistance rates of E. coli to piperacillin/tazobactam, ceftriaxone, nitrofurantoin and ciprofloxacin were significantly different from those of K. pneumoniae (p < 0.05).
Conclusions: The distribution of pathogenic bacteria complicated by UTI in patients with T2DM treated with SGLT-2 inhibitors was dominated by Gram-negative bacteria such as E. coli, some Gram-positive bacteria, and a small number of fungi. Antibiotics should be used appropriately in this population because of the pharmacological mechanism of SGLT-2 inhibitors.
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Objective: This study aims to explore the correlation of serum inhibin B, endothelin (ET) and human epididymal secretory protein 4 (HE4) with sperm quality in patients with varicocele (VC) to provide new insights for diagnosis, treatment and prognosis.
Methods: From May 2022 to February 2025, 64 patients with VC (all underwent varicocelectomy) and 64 healthy controls with matched age and body mass index (BMI) were recruited. Fasting blood and semen samples were collected early in the morning for enzyme-linked immunosorbent assay (ELISA) quantification of serum inhibin B and ET as well as seminal plasma HE4 levels. Standard semen analysis was performed to evaluate sperm concentration, motility and morphology. Correlations between biomarkers and sperm quality and VC severity were assessed using Pearson/Spearman tests. Pre- and post-operative changes were analysed using paired t-test.
Results: Patients with VC showed significantly reduced inhibin B (p < 0.05) and elevated ET and HE4 compared with the controls (p < 0.05). The combined detection using inhibin B + ET + HE4 showed sensitivity and specificity values of 89.06% and 65.63% for VC, respectively. Inhibin B exhibited a positive correlation with sperm density, total motility and progressive motility (p < 0.01), whereas ET and HE4 exhibited inverse relationships (p < 0.05). Postoperative follow-up at 3 months showed that inhibin B levels in patients with VC increased compared with the preoperative levels (p < 0.05), while the levels of ET and HE4 decreased (p < 0.05).
Conclusions: Inhibin B, ET and HE4 are closely related to sperm quality, with reduced inhibin B and statistically elevated ET and HE4 levels observed in patients with VC.
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Background: Bladder cancer has a high recurrence rate and presents postoperative challenges that impact patient recovery. Enhanced recovery after surgery (ERAS) programs, which incorporate nutritional and psychological strategies, have demonstrated benefits in perioperative care. This study evaluates the effect of a novel nutritional-psychological dual-wheel-driven ERAS protocol on postoperative outcomes in patients undergoing bladder cancer surgery.
Methods: A retrospective cohort study was conducted on patients with bladder cancer treated between January 2021 and June 2024. Participants were divided into a routine ERAS group and an enhanced support group receiving enhanced nutritional and psychological support. Perioperative outcomes, including postoperative recovery time, anxiety, nutritional status, complications and patient satisfaction were assessed between groups.
Results: The enhanced support group (n = 121) demonstrated significant improvements in postoperative recovery metrics compared with the routine group (n = 124), that is, they had reduced intensive care unit stay, faster nasogastric tube removal and earlier time to flatus, defecation and full oral diet (p < 0.05). Repeated-measures analysis of variance (ANOVA) revealed a significant interaction effect of time and group on Nutritional Risk Screening (NRS) 2002 scores (p = 0.010). The main effects of time and group were significant for NRS 2002, Self-Rating Anxiety Scale (SAS) and visual analogue scale (VAS) scores (all p < 0.05). Simple effects analysis showed lower NRS 2002 and SAS scores in the enhanced support group than in the routine group at 24 hours before surgery and 1 day after surgery (p < 0.05) but higher VAS scores (p < 0.05). Fewer wound leakage complications occurred in the enhanced support group (p = 0.031), and patient satisfaction rates were significantly higher (p = 0.003).
Conclusions: The nutritional-psychological dual-wheel-driven ERAS protocol is associated with improved postoperative recovery, reduced complications and increased patient satisfaction in patients with bladder cancer.
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Background: Although rare, testicular adenomatoid tumours are the most common benign neoplasms of the paratesticular region, particularly affecting the epididymis and spermatic cord. These benign mesothelial-derived tumours rarely undergo malignant transformation and are typically managed with surgical excision. However, their clinical presentation may mimic the tumours arising from the testis, either benign or malignant, leading to grave consequences.
Case Presentation: We report the challenging case of a 49-year-old man who presented with a painful mass in the left scrotal lower pole. Owing to the suspicious imaging features, malignancy was initially considered. Histopathological examination revealed an infarcted adenomatoid tumour. This finding is rare and emphasises the importance of accurate diagnosis to avoid overtreatment. This case report describes the microscopic and macroscopic aspects of an infarcted adenomatoid tumour of the paratesticular area, focusing on the diagnostic and therapeutic approaches.
Conclusions: This case underscores the necessity for the careful clinical and imaging evaluation of paratesticular masses. In settings where intraoperative frozen-section analysis or advanced imaging modalities are available, the application of a conservative, testis-sparing approach may be feasible. Awareness of this rare presentation can help avoid overtreatment and guide tailored surgical decision-making. Multidisciplinary collaboration is essential to balance oncological safety with the preservation of testicular function in benign conditions that mimic malignant diseases.
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Introduction: Bladder cancer (BC) is a common urological malignancy. Radical cystectomy (RC) is the standard therapeutic intervention for muscle-invasive BC (MIBC) and selected cases of non-MIBC, frequently necessitating subsequent urinary diversion. Orthotopic neobladder reconstruction is a commonly used option designed to preserve urinary continence. Delayed complications may manifest following RC and neobladder creation. This work presents a rare case of inguinoscrotal herniation involving an orthotopic neobladder, occurring 10 years after RC. To the best of our knowledge, this work is the first reported case of this complication managed through conservative treatment.
Case Presentation: A 58-year-old male with a history of RC and orthotopic neobladder substitution performed 10 years prior presented to the Emergency Department with pyrexia. Physical examination revealed a right-sided inguinoscrotal swelling. Diagnostic investigations confirmed a urinary tract infection. Ultrasonography identified the orthotopic neobladder within the hernia sac and determined a post-void residual volume of 400 cc. The patient was admitted for intravenous antibiotic therapy and correction of metabolic derangements. Planned surgical repair was deferred due to patient-specific factors and comorbidities. Manual hernia reduction was performed instead, followed by a regimen of four to six daily self-intermittent catheterisations, alongside lifestyle modifications and the prescription of a hernia truss. The patient has remained free of complications at 24 months of follow-up.
Conclusions: Inguinoscrotal herniation of an orthotopic neobladder is an uncommon delayed complication following RC. Although previous reports describe surgical correction, this work indicates that conservative management—encompassing clean intermittent catheterisation, behavioural modifications and external support—may constitute a viable alternative for selected patients unsuitable for or declining surgical intervention. Comprehensive patient education and diligent long-term surveillance are imperative for successful conservative management.
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Background: The rare metabolic disease, adenine phosphoribosyl transferase (APRT) deficiency, is asymptomatic in many cases until it is discovered in terminal renal failure. The most frequent complication is 2,8-dihydroxyadenine (2,8-DHA) urolithiasis. Stones, which are frequently bilateral and recurrent, appear in childhood in one-third of cases.
Case Report: An 8-year-old girl presented with urinary tract infection and coralliform urolithiasis in the right kidney. Initial radiological examination showed emphysematous pyelonephritis stage 1 due to obstructive lithiasis. Stone analysis helped confirm the diagnosis of APRT deficiency.
Discussion: The diagnostic difficulties, clinical manifestations, and the impact of early detection and management on preventing stone recurrence and complication were discussed. The therapeutic strategies available, including dietary modifications and allopurinol therapy, were reviewed.
Conclusions: Early intervention with therapeutic and dietetic measures could preserve the normal renal function of the young patient.
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Introduction: Metastatic renal cell carcinoma (RCC) to the bladder is extremely rare. A total of 1.6% of the patients were found via autopsy reports.
Case Presentation: A 44-year-old male patient presented with left flank pain and hematuria. A 40 mm tumor extending into the pelvis was detected in contrast-enhanced computed tomography (CECT). After benign urine cytology and transurethral-resection (TUR) biopsy from the bladder, left nephroureterectomy and ureteral cuff resection were performed because of a left endophytic renal mass and suspected upper tract urothelial carcinoma. Pathology analysis revealed papillary RCC. In the patient with hematuria, a 16mm mass was detected in the bladder 2 years after nephrectomy. Papillary type RCC was detected after complete TUR of the bladder tumor. Left iliac-lymph-node metastasis was detected via postoperative positron emission tomography-computed tomography (PET-CT). After six months of sunitinib treatment, the metastatic lymphadenopathy was found to regress on PET-CT.
Discussion: Solitary resectable intravesical metastatic RCC is a good prognostic factor. Late-onset systemic metastasis may be observed and should be considered during follow-up. PET-CT scanning should be performed if necessary, and the patient can be treated with sunitinib.
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Introduction: Segmental testicular infarction (STI) is a rare, benign condition that often mimics testicular tumours, leading to diagnostic challenges and, at times, unnecessary orchiectomies. The clinical challenge is the lack of a consensus regarding which imaging tools should be used to characterise the testicular lesions and which one is the most reliable.
Case Presentation: We report the case of a 34-year-old man presenting at the emergency department with right testicular pain and swelling. Contrast-enhanced ultrasound (CEUS) performed at our hospital revealed a poorly defined, hypoechoic lesion with peripheral rim enhancement, consistent with subacute infarction. Follow-up CEUS 1 month later showed reduction in lesion size and absence of enhancement, supporting a benign evolution. However, surgical exploration was performed because of the impossibility to fully exclude malignancy. Intraoperative frozen-section analysis confirmed haemorrhagic infarction with no signs of malignancy.
Conclusions: CEUS plays a central role in guiding diagnosis and follow-up, offering detailed assessment of testicular perfusion. Compared with conventional ultrasound and magnetic resonance imaging, CEUS is faster, safer, more cost-effective and highly accurate in differentiating infarction from hypovascular tumours. This case study supports the growing use of CEUS as a first-line imaging modality in the evaluation of testicular lesions, promoting conservative management and avoiding overtreatment in appropriate clinical settings.
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Background: Prostatic extra-gastrointestinal stromal tumors (EGISTs) are notably uncommon, and the effectiveness of radical prostatectomy in managing these tumors has not been definitively established.
Case Summary: A male patient, aged 71, with a history of two previous bowel resections, reported to the Department of Urology exhibiting symptoms of frequent urination, urgency, and difficulty in defecation persisting for three years. A digital rectal examination indicated the prostate was considerably enlarged, smooth, and firm. The concentrations of total serum total prostate-specific antigen (PSA) and free PSA were recorded at 0.15 ng/mL and 0.04 ng/mL, respectively. A transrectal ultrasound (TRUS) revealed a hypoechoic mass within the prostate, measuring 14.1 × 11.9 × 11.1 cm. Subsequent magnetic resonance imaging (MRI) showed a large, distinct lesion characterized by aggressive growth that compressed the adjacent rectum and bladder, initially suggesting a prostate sarcoma originating from the interlobular tissues. Guided by TRUS, a prostate biopsy indicated the presence of either a benign mesenchymal tumor or a solitary fibrous tumor (SFT). The patient was treated with radical prostatectomy, cystectomy, urinary diversion, and colostomy, leading to the final diagnosis of an EGIST. Throughout a follow-up of seven years, there was no sign of tumor recurrence.
Conclusion: Prostatic EGISTs, while exceedingly rare, require differentiation from other neoplasms such as sarcomas and SFTs. Radical prostatectomy has demonstrated efficacy as a treatment option for these resectable tumors.
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Background: Bladder cancer is a common malignant tumor of the urinary system. Although lymphoepithelial carcinoma can occur in the liver, breast, thymus, lungs, skin, and other organs, its presence in the urinary system is exceptionally rare.
Methods: We report the case of a 50-year-old man who presented to our hospital with hematuria. Urinary tract computed tomography revealed a malignant bladder tumor, with an enhancing nodule measuring 9 mm in the posterior wall of the bladder. The patient received transurethral resection of the bladder tumor, followed by arterial embolization chemotherapy and intravenous chemotherapy combined with immunotherapy successively, and finally underwent cystoscopy follow-up to monitor the condition.
Results: After transurethral resection of the bladder tumor, immunohistochemistry revealed tumor cells appearing as syncytial bodies with unclear boundaries. The nuclei were large and vacuolated, with marked infiltration of lymphoplasmacytes observed both between and within the tumor islands. The markers were as follows: cytokeratin 7 (CK7) (+), CK20 (–), S-100 (–), prostate-specific antigen (PSA) (–), Desmin (–), Melanoma (–), Epstein-Barr virus-encoded RNA (EBER) (–), spalt like transcription factor 4 (SALL4) (–), P63 (–), CKpan (+), GATA binding protein 3 (GATA-3) (–), epithelial membrane antigen (EMA) (+), P40 (–), cluster of differentiation (CD)117 (+), CD20 (–), CD3 (–), CD30 (–), placental alkaline phosphatase (PLAP) (–), CD15 (small weak+), and Ki67 (35%+). The patient was diagnosed with lymphoepithelial carcinoma.
Conclusions: The patient remained recurrence-free at 11 months of follow-up after gemcitabine bladder infusion chemotherapy, arterial drug-infusion embolization, systemic chemotherapy, and immunotherapy.
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