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Background: Studies examining anatomical changes in the prone position during endourological procedures lack predictive formulas for estimating the renal pelvis-to-skin distance (KSD). Furthermore, existing equations for renal depth—an important parameter for accurate glomerular filtration rate (GFR) assessment—are based on supine measurements. This study aimed to develop predictive formulas for estimating renal depth in the prone position for patients undergoing percutaneous renal access.
Methods: A total of 86 healthy volunteers (46 men, 40 women) were enrolled in a prospective study conducted at the 2nd Department of Urology, Papageorgiou General Hospital between June and September 2020. Participants completed a questionnaire on medical history, demographic, and somatometric characteristics. Renal KSD was measured ultrasonographically in the prone position using a convex probe placed parallel and 1 cm below the 12th rib, with the posterior axillary line as a landmark. The biopsy line targeted the midpoint of the renal pelvis. Distances were analyzed in relation to clinical and anthropometric variables, and predictive equations were generated for each kidney.
Results: The following equations were derived: left kidney: distance = 1.5 + 0.272 × body mass index (BMI) − 0.452 × gender; right kidney: distance = 1.619 + 0.259 × BMI − 0.457 × gender (BMI: gender coded as 0 = male, 1 = female). Mean renal depth was 7.81 cm for the right kidney and 8.23 ± 1.47 cm for the left. Distances were significantly greater in men (p = 0.004 right; p = 0.005 left). A strong positive correlation was observed between right and left kidney depths (r = 0.859, p < 0.001), as well as with body weight and waist circumference. In men, greater right kidney depth was associated with hypertension, low high-density lipoprotein (HDL), and metabolic syndrome (p < 0.05).
Conclusions: These formulas provide a simple and reliable method for estimating renal depth in the prone position, potentially improving procedural accuracy and patient safety during percutaneous renal access.
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Background: Iatrogenic ureteral injury (IUI) is a rare but serious complication of abdominal and pelvic surgery, often leading to substantial morbidity and additional surgical interventions. This study aimed to evaluate the association of the diagnostic pathway (intraoperative diagnosis with immediate repair versus postoperative diagnosis with delayed repair) with perioperative and functional outcomes.
Methods: In this study, 92 patients who underwent reconstructive surgery for IUI between 2015 and 2025 were retrospectively analyzed. The patients were stratified into early and delayed repair groups, and injuries were classified as thermal full-thickness injury, thermal ischemic injury, or non-thermal full-thickness injury. Perioperative, postoperative, and functional outcomes were compared.
Results: Of the 92 patients, 62 (67.4%) underwent early repair and 30 (32.6%) delayed repair. Delayed repair was associated with a longer hospital stay [9 (7–12.5) vs. 7 (5–7) days; p = 0.004], higher rates of percutaneous nephrostomy (83.3% vs. 0%; p <0.001), and reoperation (16.7% vs. 0%; p = 0.003). Overall complication, nephrectomy, hydronephrosis, and long-term renal functional loss rates were comparable between groups. Thermal ischemic injury was associated with significantly higher postoperative complication rates than thermal full-thickness and non-thermal full-thickness injuries (53.3% vs. 25.0% vs. 23.1%, respectively; p = 0.021).
Conclusions: A delayed diagnostic pathway, resulting in delayed reconstruction, was associated with prolonged hospitalization, greater need for urinary diversion, and higher reoperation rates. Thermal ischemic strictures represented a distinct subgroup with an increased risk of postoperative complications. These findings highlight the importance of early recognition and appropriate reconstructive management in patients with IUI.
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Objective: The most common genitourinary complication of brucellosis is Brucella epididymo-orchitis (BEO), which, if not promptly diagnosed and treated, may lead to severe testicular complications. The present study aimed to evaluate the frequency, clinical characteristics, laboratory findings, and treatment outcomes of BEO in an endemic region.
Methods: This retrospective cohort study included male patients diagnosed with brucellosis between August 2017 and October 2022 at a tertiary referral center. We identified patients with BEO based on clinical, laboratory, and ultrasonographic findings and analyzed the demographic characteristics, clinical presentation, laboratory parameters, microbiological findings, treatment regimens, and follow-up outcomes.
Results: Among 278 male patients with brucellosis, 16 patients (5.75%) were diagnosed with BEO. The median age was 42 (32–55) years. All patients had scrotal pain and scrotal swelling. The most predominant clinical form was acute brucellosis (68.75%). Bilateral testicular involvement was observed in one patient (6.25%). Brucella Coombs and Rose Bengal tests were positive in all patients, while blood culture positivity was detected in 37.50% of cases. Patients who had BEO had significantly higher white blood cell counts than those who did not have BEO (p = 0.038). All patients received combined antimicrobial therapy. Relapse occurred in five patients (31.25%), all of whom responded favorably to modified antibiotic regimens. No patient required orchiectomy or developed severe complications during the follow-up period.
Conclusions: BEO remains a significant complication of brucellosis in endemic regions and should be taken into account in the differential diagnosis of epididymo-orchitis (EO). Early diagnosis and prompt combined antimicrobial therapy appear highly effective in preventing severe complications and unnecessary surgical intervention.
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Background: Redo orchiopexy is usually evaluated based on the position of the scrotum after surgery, but satisfactory scrotal placement may not necessarily reflect preserved long-term testicular growth. In this study, we evaluated whether the early postoperative testicular volume ratio (TVR) is associated with long-term growth failure after unilateral redo orchiopexy in children.
Methods: This retrospective single-center cohort study included children who underwent unilateral redo orchiopexy between January 2013 and January 2023. Early postoperative ultrasonography was performed 6–12 months after surgery, and subsequent follow-up ultrasonography was performed at ≥24 months. TVR was calculated as the operated testicular volume divided by the contralateral testicular volume × 100. Long-term growth failure was defined as long-term TVR <50% and/or the absence of an interval increase in operated testicular volume beyond expected ultrasonographic measurement variability. The discrim inative ability of early TVR was assessed using receiver operating characteristic (ROC) analysis. The ROC-derived cutoff was considered exploratory because it was derived and evaluated in the same cohort.
Results: Sixty-eight children met the inclusion criteria. The mean age at redo orchiopexy was 7.8 ± 2.9 years, and the median follow-up was 36 months. Long-term growth failure occurred in 20 patients (29.4%). Children with growth failure had significantly lower early TVR than those with preserved growth (48.6 ± 13.2% vs. 80.4 ± 16.8%, p < 0.001). Early TVR showed good apparent discrimination, with an area under the curve (AUC) of 0.84 (95% confidence interval [CI], 0.72–0.96). In the exploratory multivariable model, each 10-percentage-point increase in early TVR was associated with a lower odds of growth failure (odds ratio [OR] 0.56; 95% bootstrap CI 0.36–0.84). The apparent model AUC was 0.86, and the optimism-corrected AUC after 1000 bootstrap resamples was 0.81. The exploratory 55% cutoff yielded 82% sensitivity, 78% specificity, 69% positive predictive value, and 88% negative predictive value.
Conclusions: Early postoperative TVR is associated with long-term testicular growth failure after unilateral redo orchiopexy. A TVR of approximately 55% may help identify children who require closer ultrasonographic surveillance, but this threshold is hypothesis-generating and requires external validation before clinical implementation. TVR should be interpreted as an imaging-based risk stratification marker rather than a direct measure of endocrine, fertility, or histologic testicular function.
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Background: Same-day discharge and early telehealth follow-up are increasingly combined after minimally invasive benign gynecologic and urogynecologic surgery, but pathway-level evidence is limited. We evaluated the observed combination of same-day discharge and a completed telehealth contact within 48–72 hours in relation to 30-day healthcare utilization, direct institutional cost, recovery, and adverse events.
Results: The combined pathway was completed by 142 of 212 eligible patients (67.0%). In the primary weighted comparison with no same-day discharge/no telehealth, it was not associated with lower 30-day healthcare utilization (risk ratio 0.72, 95% confidence interval 0.47–1.09; p = 0.122). A binary comparison with all other pathways was also null (risk ratio 1.00, 95% confidence interval 0.68–1.48; p = 0.987). Pairwise augmented inverse probability weighting and targeted maximum likelihood estimation both yielded a risk ratio of 0.61 (95% confidence interval 0.41–0.81; p < 0.001), but residual imbalance remained, estimates varied by method, and these pairwise estimates are susceptible to exposure-timing bias and are not interpreted as causal. Mean nominal direct cost was 56,601 versus 69,882 Turkish lira (cost ratio 0.87, 95% confidence interval 0.83–0.91; p < 0.001). Because the ratio compares contemporaneous groups, it was robust to inflation across the study period. Median time to return to normal activity was 13.25 versus 16.4 days and was descriptive only. Any 30-day safety event occurred in 15.5% versus 28.9% (penalized odds ratio 0.45, 95% confidence interval 0.19–1.02; p = 0.057).
Conclusions: The observed same-day-discharge-plus-telehealth pathway was consistently associated with lower direct institutional cost across analytic approaches, whereas evidence for a reduction in 30-day healthcare utilization was not robust across methods. Given the observational design, potential exposure-timing bias, limited effective sample size, and residual confounding, these associations should not be interpreted as causal effects of the pathway on healthcare utilization or clinical outcomes. No clear excess of short-term adverse events was identified, although safety equivalence was not established. Prospective multicenter studies should account explicitly for the timing of telehealth completion.
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Background: To determine the duration of delay in healthcare-seeking among women with urinary incontinence (UI), compare the sociodemographic and clinical characteristics of early and delayed consulters, and investigate sociocultural determinants associated with delayed healthcare-seeking behavior.
Methods: This cross-sectional study included 154 women presenting with UI to the Urology Outpatient Clinic of Bursa Yuksek Ihtisas Training and Research Hospital between March and June 2026. UI severity was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), quality of life using the Incontinence Quality of Life Questionnaire (I-QOL), and sociocultural determinants using the Urinary Incontinence Help-Seeking Scale (UI-HSS), developed by the researchers. Participants were categorized into early consultation (≤1 year) and delayed consultation (>1 year) groups. Factors associated with delayed consultation were evaluated using logistic regression analysis.
Results: Overall, 40.3% of participants delayed seeking medical care for more than one year after symptom onset. Women with delayed consultation had lower educational attainment, higher ICIQ-SF scores, and lower I-QOL total scores (all p < 0.001). Scores for illness perception, embarrassment and consultation barriers, normalization beliefs, lack of social support, and fatalism were also significantly higher among delayed consulters (all p < 0.05). Increasing consultation delay was associated with greater symptom severity and poorer quality of life. In multivariable analysis, higher educational level (odds ratio [OR] = 0.57, p = 0.001) and higher I-QOL total score (OR = 0.93, p = 0.005) were associated with lower odds of delayed consultation. Prior use of alternative treatments was also associated with lower odds of delayed consultation (OR = 0.43, p = 0.036).
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Objective: To evaluate the association between Relinqing Granules combined with levofloxacin and early postoperative outcomes in patients with infected kidney stones undergoing percutaneous nephrolithotomy (PCNL).
Methods: This single-centre retrospective cohort study included 198 patients with infected kidney stones who underwent PCNL between October 2023 and October 2025. All patients received standardised preoperative antimicrobial therapy, and surgery was performed after initial clinical stabilisation. Patients were retrospectively classified into a control group (levofloxacin, n = 98) or a study group (levofloxacin plus Relinqing Granules, n = 100) according to postoperative medication records. Propensity score matching was performed to control confounding bias, with 92 cases in each group matched in a 1:1 ratio. The primary outcomes included bacterial clearance rate and inflammatory markers (blood white blood cell count (WBC), urinary leukocyte count, high-sensitivity C-reactive protein, procalcitonin, and interleukin-6) at 2 weeks after surgery. Secondary outcomes included postoperative renal function parameters at 2 weeks and the stone-free rate (SFR) at 3 months after surgery. The safety outcome was evaluated 2 weeks after surgery based on the incidence of adverse events.
Results: Baseline characteristics were comparable between groups (all p > 0.05). At 2 weeks postoperatively, inflammatory markers decreased significantly from baseline in both groups and were lower in the study group than in the control group (all p <0.05). The bacterial clearance rate was significantly higher in the study group than in the control group at the same time point (92.31% vs 78.79%, p = 0.028). The SFR at 3 months after surgery was also significantly higher in the study group (92.39% vs 82.61%, p = 0.045). The incidence of adverse events was similar between the two groups.
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Background: Urosepsis is a life-threatening complication of urinary tract infection (UTI) associated with high mortality. Early identification of patients at high risk of poor outcomes remains challenging due to the limited predictive value of single biomarker.
Results: The levels of hsCRP, PCT, Scr, β2-MG, and u-ORM/u-CREAT were significantly higher in the poor prognosis group than in the favourable prognosis group (all p < 0.001). Multivariable analysis identified hsCRP >85.3 mg/L, PCT >5.7 ng/mL, Scr>132 µmol/L, andu-ORM/u-CREAT>18.5 mg/mmol as independent predictors of poor prognosis (all p <0.05). Acombined model of hsCRP, PCT, Scr, and u-ORM/u-CREAT achieved the highest predictive performance, with an area under the ROC curve of 0.923, sensitivity of 86.9% sensitivity and specificity of 84.3%, and outperformed individual marker (all p < 0.05).
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Methods: This retrospective study included 213 patients aged 45–85 years who underwent prostate mpMRI between May 2020 and May 2025. A deep learning AI system was used to analyse the mpMRI images to obtain parameters of the primary prostate lesion. Using pathological results as the gold standard, the diagnostic value of mpMRI parameters in prostate cancer was analysed.
Results: Among the 213 patients, 72 had prostate cancer (clinically significant prostate group) and 141 did not (non clinically significant prostate group). The mean age was (72.7 ± 7.4) years, and the mean body mass index was (25.7 ± 3.9) kg/m2. Compared with the non-clinically significant prostate cancer (non-csPCa) group, the clinically significant prostate cancer group had significantly lower ellipsoid volume and segmented prostate volume (p < 0.05). Pearson analysis showed negative correlation between PSA level and segmented prostate volume in all patients with prostate cancer (r = −0.449, p < 0.01). PSA level, apparent diffusion coefficient (ADC), maximum lesion diameter, peripheral-zone signal intensity, and the prostate-specific antigen density (PSAD) derived from mpMRI exhibited strong predictive value for prostate cancer (p < 0.05).
Conclusions: The AI-based mpMRI can enhance diagnostic value for clinically significant prostate cancer and provide valuable insights into tumour invasiveness, potentially guiding more informed clinical decisions and reducing unnecessary biopsies.
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Background: Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney and accounts for the majority of renal malignancies. The detection of small RCCs has increased in recent years, largely owing to advances in imaging techniques. To date, few studies have investigated the diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating clear cell renal cell carcinomas (ccRCCs) from non-clear cell renal cell carcinomas (non-ccRCCs) when smaller than 4cm. In this study, we aimed to retrospectively explore the value of conventional ultrasound combined with CEUS in differentiating the two main RCC subtypes.
Methods: Altogether, 84 RCC cases were included, comprising 62 ccRCCs and 22 non-ccRCCs. All patients underwent conventional ultrasound and CEUS before surgery. To determine the independent predictors of small ccRCC, we conducted univariate and multivariate logistic regression analyses on the clinical data and ultrasound imaging features of the patients. Receiver operating characteristic (ROC) curve analysis was performed to assess diagnostic performance.
Results: Multivariate logistic regression identified cystic change (odds ratio (OR) = 5.959; p = 0.017), parenchymal phase isoenhancement (reference: hypo-enhancement; OR = 6.411; p = 0.007), and hyperenhancement (reference: hypo-enhancement; OR = 15.770; p < 0.001) as independent predictors for distinguishing between small ccRCC and non-ccRCC. Routine ultrasound combined with CEUS demonstrated good evaluation efficacy, with an area under the curve (AUC) of 0.823 (95% confidence interval: 0.733–0.914).
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Background: Bladder cancer exhibits substantial molecular heterogeneity, and adverse epithelial programs remain incompletely characterized at single-cell resolution. This study aimed to identify candidate epithelial programs and derive genes supporting prognostic modeling.
Methods: Single-cell RNA sequencing data were analyzed to annotate epithelial subtypes and infer malignant populations. Bulk transcriptomic cohorts were used for Cox regression, risk-model construction, pathway analysis, immune characterization, and cell-cell communication inference. Stearoyl-CoA desaturase (SCD) was experimentally assessed in bladder cancer cells.
Results: We identified 14 epithelial subtypes with cell-level differences across pathological T stages. C05 Epithelial-S100A9 showed basal-like features, proliferative signaling, and adverse program-level survival associations. GSE130001 showed broad C05-signature activity but no discrete C05-like subpopulation. From this program, we derived a four-gene signature comprising epoxide EPHX1, SCD, LDLR, and TSPAN8. High-risk tumors were enriched for epithelial-mesenchymal transition, collagen-associated pathways, immune-checkpoint expression, and fibroblast-related signaling. SCD knockdown reduced proliferation and migration.
Conclusions: This study characterizes a candidate S100A9-associated epithelial program and a single-cell-informed prognostic framework linked to stromal and immune features. These findings suggest potential prognostic relevance, but independent single-cell analyses, mechanistic studies, and prospective validation remain required.
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Objective: Diabetes and alkaline phosphatase (ALP) may be associated with kidney stone risk. This investigation aimed to assess the relationship between hemoglobin glycation index (HGI) and kidney stone risk in non-diabetic individuals, and evaluate the role of ALP within this association.
Materials and Methods: Non-diabetic individuals aged 20 and above from the National Health and Nutrition Examination Survey (NHANES) (2007–2020) were incorporated into this cross-sectional study. HGI and ALP values were each stratified into tertiles. The association of HGI and ALP with kidney stone risk was investigated using a logistic regression model. Mediation analysis was performed to examine whether ALP acts as a potential mediator linking HGI to kidney stone risk.
Results: The analysis cohort comprised 12,103 non-diabetic individuals, of whom 985 (weighted percentage: 8.53%) had kidney stones, and 11,118 (weighted percentage: 91.47%) did not. HGI values ≥0.092 (vs. <0.092) [odds ratio (OR) = 1.22 (95% confidence interval (CI): 1.01–1.46)] and ALP levels ≥73 U/L (vs. <73) [OR = 1.22 (95% CI: 1.01–1.46)] were associated with a higher kidney stone risk. In the mediation analysis, the β value was 0.0153 (95% CI: 0.0056–0.0262) for the average direct effect (ADE) and 0.0007 (95% CI: 0.0002–0.0013) for the average causal mediation effect (ACME). ALP mediated 4.56% (95% CI: 1.07%–16.6%) (p < 0.001) of the total association between HGI and kidney stone risk.
Conclusions: Higher HGI levels were associated with an elevated kidney stone risk in non-diabetic individuals, and ALP partially mediated this association.
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Background: Hemorrhaging continues to be a significant issue in endoscopic procedures for benign prostatic hyperplasia (BPH). Tranexamic acid (TXA) has garnered heightened scrutiny for its ability to mitigate bleeding-associated problems during transurethral prostate procedures. We performed a comprehensive meta-analysis to assess the effectiveness and safety of TXA in individuals having endoscopic procedures for BPH, acknowledging that the existing data primarily originated from transurethral resection of the prostate (TURP).
Methods: PubMed,WebofScience, CochraneLibrary, Embase, CNKI, Wanfang,Clinical Trials.gov, and ICTRP were examined from the beginning of their databases until April 2026. Pooled mean differences (MDs) and risk ratios (RRs) together with 95% confidence intervals (CIs) were computed utilizing RevMan 5.4. Sensitivity analyses and assessment of publication bias were performed using R version 4.4.2.
Results: Fifteen randomized controlled studies with 1,310 people were qualified. Compared to the control group, TXA significantly reduced operational time (MD =–6.49 minutes, 95% CI:–10.79 to–2.20) and intraoperative blood loss (MD =–66.68 mL, 95%CI:–123.84 to–9.51). TXA also led to significantly less hemoglobin loss at 24 hours (MD =–0.58 g/dL, 95% CI:–0.88 to–0.29) and decreased irrigation fluid volume (MD =–0.45 L, 95% CI:–0.80 to–0.10). However, there were no significant differences between groups in duration of continuous bladder irrigation, catheterization time, length of stay, weight of resected adenoma, blood transfusion requirements, incidence of deep vein thrombosis (DVT) or quality of endoscopic.
Conclusions: TXA correlated with less intraoperative hemorrhage, decreased hemoglobin depletion after 24 hours, reduced irrigation fluid usage, and shortened surgical duration in endoscopic procedures for BPH. These results should be regarded primarily as evidence from TURP, demonstrating consistent effects across both monopolar and bipolar subgroups. Evidence outside TURP was limited to a single holmium laser enucleation of prostate RCT, which contributed data only to operative time among the statistically significant outcomes. Reported DVT were rare, and the available evidence remains underpowered to determine the thromboembolic safety profile of TXA. Additional RCTs are necessary to elucidate the function of TXA in various surgical methodologies and among patients with an elevated risk of hemorrhage.
The PROSPERO Registration: The study was registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251044211; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251044211).
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Background: This study aimed to systematically assess the relationship between metabolic syndrome (MetS) and the incidence of bladder cancer. Methods: We performed a comprehensive search of the PubMed, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus databases to retrieve eligible cohort studies. Pooled relative risk (RR) and corresponding 95% confidence interval (CI) were estimated using a random-effects model. Robustness was checked via a leave-one-out sensitivity analysis. Publication bias was assessed both graphically (funnel plots) and statistically (Begg’s and Egger’s tests).
Results: The final meta-analysis incorporated six studies, encompassing a total population of over 13 million individuals and 22,000 newly diagnosed cases. The aggregated data revealed that MetS was associated with a statistically significant 12% elevation in bladder cancer risk (RR = 1.12; 95% CI: 1.03–1.22). Sensitivity analysis demonstrated the stability of these results, and no evidence of significant publication bias was observed. Substantial heterogeneity was observed across studies (I2 = 62.4%, p = 0.009). Sensitivity analysis demonstrated the robustness of the pooled estimate. Exclusion of any single study did not materially alter the overall conclusion. Begg’s test produced a p-value of 0.711, while Egger’s test showed a p-value of 0.062.
Conclusions: MetS is linked to a moderately higher risk of developing bladder cancer. These results underscore the importance of maintaining metabolic health as a potential strategy for bladder cancer prevention.
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Methods: This retrospective cohort study included 200 patients with complex urinary tract stones who received PCNL treatment at The Second People’s Hospital of Chun’an County between January 2023 and January 2026. Participants were divided into a control group (100 cases) and a full-course nursing group (100 cases) based on different nursing methods. After 1:1 propensity score matching, 85 patients were retained in each group. The control group received routine perioperative nursing, whereas the full-course nursing group received full-course nursing management based on routine care, including preoperative risk assessment and health education, infection prevention, intraoperative collaborative nursing, postoperative management (drainage tube management, pain management, and early rehabilitation training), and post-discharge follow-up. Preoperative and postoperative renal function indicators [serum creatinine (Scr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR)], inflammatory markers [C-reactive protein (CRP), procalcitonin (PCT)], incidence of urinary tract infections, postoperative complication rates, length of hospital stay, and nursing satisfaction were compared between the two groups.
Conclusions: Perioperative comprehensive nursing management was associated with better postoperative renal function, lower incidences of urinary tract infection and related complications, and shorter hospital stay in patients with complex urinary tract stones undergoing PCNL, suggesting potential clinical value.
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Objective: To evaluate the effectiveness and safety of lobaplatin versus epirubicin or gemcitabine for intravesical instillation in post-therapy following transurethral resection of bladder tumour (TURBT) non-muscle-invasive bladder cancer (NMIBC) patients in the absence of randomized evidence.
Methods: This retrospective study analysed clinical data from 522 NMIBC patients who received postoperative intravesical therapy with lobaplatin (n = 121), epirubicin (n = 128), or gemcitabine (n = 273) at tertiary hospitals in China between 2019 to 2022. Key tumour-specific factors, including T stage (Ta, T1), tumour grade, were collected from medical records. Given the non-randomized nature of real-world data, propensity score matching (PSM) was applied to reduce baseline imbalance. For the lobaplatin vs. epirubicin comparison, PSM included age, sex, smoking history, tumour location, surgical history, surgical method, and need for secondary resection. For the lobaplatin vs. gemcitabine comparison, PSM included sex, tumour location, surgical method, and requirement for re-resection. The study compared 1-year and two-year recurrence-free survival (RFS), progression to muscle-invasive bladder cancer (MIBC), and treatment related dose adjustments.
Results: After PSM, 79 patients were in each of the lobaplatin and epirubicin groups, and 119 patients were in each of the lobaplatin and gemcitabine groups. Lobaplatin and epirubicin showed comparable 1-year (100% vs. 98.73%, p = 0.32) and 2-year RFS rates (98.67% vs. 97.45%, p = 0.57). In the lobaplatin versus gemcitabine comparison, the 1-year RFS rates were 97.48% and 90.69%, respectively (p = 0.026), and the 2-year RFS rates were 95.75% and 88.98%, respectively (p = 0.047). Dose adjustments were less frequent with lobaplatin than with epirubicin (31.65% vs. 51.90%, p = 0.010) and comparable between lobaplatin and gemcitabine (24.37% vs. 24.37%, p > 0.999).
Conclusions: In this real-world retrospective cohort, lobaplatin instillation showed comparable effectiveness to epirubicin and differences in outcomes compared with gemcitabine in post-TURBT NMIBC, with fewer dose adjustments compared to epirubicin.
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Background: Screening clinical factors related to poor urinary control 3 months after radical prostatectomy and constructing a risk prediction model for early postoperative urinary control dysfunction.
Methods: Retrospective inclusion of clinical data from 300 patients undergoing radical prostatectomy, divided into a modeling cohort (n=210) and a randomized split internal validation cohort (n=90) in a 7:3 ratio. Extract preoperative demographic, oncology, imaging, and rehabilitation related variables; Using Least Absolute Shrinkage and Selection Operator Regression (LASSO) to screen for factors related to early postoperative urinary control in prostate cancer patients undergoing radical prostatectomy, the statistically significant variables selected by LASSO were included in a multivariate logistic regression analysis to further explore the independent influencing factors of early postoperative urinary control. A nomogram was built, and its discrimination, calibration and clinical net benefit were evaluated via receiver operating characteristic (ROC) analysis, 1000-bootstrap calibration curves and decision curve analysis (DCA), followed by internal validation.
Results: Preoperative baselines were comparable between cohorts (p > 0.05). Univariate analysis shows that there are eight variables with differences. LASSO regression screening yielded five variables: age, body mass index (BMI), previous transurethral resection of the prostate (TURP), prostate volume, and regular pelvic floor muscle training. Multivariate logistic regression analysis showed that older age, higher BMI, history of TURP, and larger prostate volume were all associated with a higher risk of urinary incontinence; There is a correlation between regular pelvic floor muscle training and a reduced risk of urinary incontinence (p < 0.05). The nomogram achieved good discrimination in the modeling set [area under the curve (AUC) = 0.849, 95% confidence interval (CI) 0.7904–0.9076], with bootstrap calibration showing consistent predicted and actual risks. DCA confirmed superior net benefit over “Treat all” and “Treat none” within the 0–0.60 threshold range. Internal validation yielded an AUC of 0.750 (95% CI 0.633–0.868), with acceptable calibration and steady net benefit despite slightly lower discriminative ability.
Conclusions: The postoperative early risk stratification nomogram constructed in this study has acceptable discrimination and calibration, and can only be used as a preliminary screening tool to evaluate the risk of poor urinary control recovery 3 months after radical prostatectomy. It can provide auxiliary reference for postoperative rehabilitation decision-making.
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Objective: To assess the association of preoperative neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) with postoperative bladder stone recurrence, and to improve risk stratification in patients with benign prostatic hyperplasia (BPH) and bladder stones.
Methods: This retrospective cohort included 202 patients who underwent holmium laser enucleation of the prostate combined with bladder lithotripsy between July 2022 and June 2024. The primary Cox model included age, diabetes, recurrent urinary tract infection (UTI), postvoid residual urine volume, NLR, and CRP. A clinical model was compared with a clinical + NLR + CRP model using the C-index, 24-month time-dependent area under the curve (AUC), Brier score, calibration, bootstrap validation, and decision-curve analysis. Matched and restricted-cohort analyses assessed robustness.
Results: During 18–42 months of follow-up, 42 patients (20.8%) developed recurrent bladder stones. In the adjusted Cox model, higher NLR (hazard ratio [HR] = 2.06, 95% confidence interval [CI]: 1.39–3.05, p < 0.001) and CRP (HR = 1.07 per 1 mg/L, 95% CI: 1.02–1.12, p = 0.005) were associated with a higher hazard of bladder stone recurrence. Adding NLR and CRP increased the C-index from 0.681 to 0.754 and the 24-month AUC from 0.693 to 0.771, while reducing the Brier score from 0.162 to 0.143. The optimism-corrected C-index was 0.741. Decision-curve analysis indicated an incremental net benefit mainly across threshold probabilities of approximately 12%–35%. Results remained directionally consistent in all sensitivity analyses. With an exploratory NLR cutoff of 2.24, 24-month recurrence-free survival was 91.0% for NLR ≤ 2.24 and 78.5% for NLR > 2.24 (log-rank p = 0.002).
Conclusions: Higher preoperative NLR and CRP were associated with bladder stone recurrence and provided incremental value for internal risk stratification beyond selected clinical factors. External validation is required before clinical use.
Case Report
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Background: Synchronous bilateral renal cell carcinoma (RCC) is an uncommon clinical presentation that raises important diagnostic, surgical, and oncological management challenges. Colonic serosal metastases from RCC represent a particularly rare site of spread.
Case summary: We report the case of a 67-year-old man with synchronous bilateral clear cell RCC (ccRCC) who underwent staged nephrectomies in 2022, followed by early multifocal recurrence necessitating completion left nephrectomy, bilateral adrenalectomy, and segmental colectomy for serosal colonic involvement in October 2023. Pathology confirmed metastatic ccRCC at all resected sites. Adjuvant pembrolizumab was initiated post-resection but failed to prevent rapid systemic progression with bone and pulmonary metastases. Following adjuvant immunotherapy failure, the patient received three sequential lines of targeted therapy in the metastatic setting: sunitinib (first line), everolimus (second line), and cabozantinib (third line). Cabozantinib achieved a durable metabolic response, with complete resolution of nodal disease and partial response of bone and pulmonary lesions, despite prior multiline exposure. Treatment was complicated by medication-related osteonecrosis of the jaw, requiring temporary discontinuation; cabozantinib was reintroduced at a reduced dose (20 mg/day), which was associated with maintained disease control and acceptable tolerance. At the time of reporting, the patient remained on reduced-dose cabozantinib with chronic hemodialysis and hormonal replacement, maintaining an Eastern Cooperative Oncology Group (ECOG) performance status of 0.
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