Review
Knowledge map
Save
Androgen deprivation therapy (ADT) represents a cornerstone in the treatment of prostate cancer (PC); however, its use is associated with an accelerated deterioration of bone health as a consequence of treatment-induced hypogonadism. Patients receiving ADT experience a rapid loss of bone mineral density (BMD), especially during the first year of therapy, leading to a clinically significant increase in the risk of osteoporosis and fragility fractures. These bone complications are associated with a significant negative impact on quality of life, morbidity and mortality, and healthcare costs.
This article aims to provide a critical and practical review of pathophysiology, risk factors, assessment methods, and strategies for the prevention and treatment of ADT-induced bone loss in patients with prostate cancer. Current recommendations from major clinical guidelines are analyzed, highlighting the importance of systematic bone risk assessment using bone densitometry and risk stratification tools like Fracture Risk Assessment Tool (FRAX®). Evidence-based interventions are also reviewed, ranging from lifestyle modifications and calcium and vitamin D supplementation to the use of antiresorptive therapies in selected patients, to provide a comprehensive and clinically applicable approach for daily practice.
Review
Knowledge map
Save
Article
Knowledge map
Save
Background: Postoperative radiotherapy (RT) is an established treatment for biochemical recurrence (BR) after prostatectomy. Moderate hypofractionation offers potential radiobiological and logistical advantages, although evidence for non-escalated postoperative RT schedules remains limited. This study evaluated oncological outcomes in patients with a hypofractionated postoperative RT.
Methods: We retrospectively analyzed 189 patients with prostate cancer treated with postoperative hypofractionated RT to the prostate bed (55 Gy in 20 fractions). RT was delivered as salvage or adjuvant treatment according to pathological and biochemical findings. Survival outcomes and predictive factors were assessed using Kaplan-Meier and multivariable analyses.
Results: Most patients received salvage RT, with a median pre-RT prostate-specific antigen (PSA) of 0.61 ng/mL. High-risk pathological features were common, and 26.3% developed BR after treatment. 5-year disease-free survival reached 93.8%, while 5-year overall survival (OS) was 96.6%. Postsurgical grade, pre-RT PSA, nodal involvement, and androgen deprivation therapy (ADT) were associated with outcomes.
Conclusions: Non-escalated hypofractionated postoperative RT yields favorable local disease control accompanied by acceptable safety toxicity profiles, supporting its application as an effective and practical alternative to conventional fractionation regimens. Further prospective clinical studies are needed to clarify the potential therapeutic role of dose escalation in routine postoperative treatment setting.
Article
Knowledge map
Save
Background: Cancer-associated thrombosis (CAT) is a frequent and clinically relevant complication in patients with genitourinary (GU) malignancies, but real-world data focused on this population are limited. We describe the clinical characteristics, management, and outcomes of venous thromboembolism (VTE) in patients with GU cancers.
Methods: We performed a retrospective analysis of patients with GU malignancies included in the registry of Thrombosis and nEoplasia of SEOM (TESEO). Adult patients with histologically confirmed GU cancer and radiologically proven VTE were included.
Results: Data on a total of 337 patients were analyzed; most of the patients (75.4%) had advanced disease. Pulmonary embolism was the most frequent presentation (56.2%), and 51.2% of events were incidentally diagnosed. Median time from cancer diagnosis to VTE was 9 months, with shorter intervals observed in germ cell tumors. Low-molecular-weight heparin was the most commonly used anticoagulant (88.2%). Bleeding complications occurred in 11.3% of patients, mainly during the first month of treatment, with GU bleeding being the most frequent. Recurrent VTE was observed in 4.1% of patients. Median overall survival was 59 months and did not differ according to thrombotic characteristics. However, among patients with bladder cancer, bleeding events were associated with worse overall survival (adjusted hazard ratio 2.82; 95% confidence interval, 1.13–7.04; p = 0.019 by log-rank test).
Conclusions: In this real-world cohort, CAT in GU malignancies predominantly occurred in advanced disease and was frequently diagnosed incidentally. Overall survival was mainly influenced by tumor-related factors, although bleeding events negatively affected outcomes in patients with bladder cancer, underscoring the need for individualized anticoagulation strategies.
Article
Knowledge map
Save
Background: Very high-risk (VHR) bladder tumors represent a subcategory of non-muscle-invasive bladder cancer (NMIBC) with a high potential for progression to muscle-invasive bladder cancer (MIBC). Early radical cystectomy (ERC) is the standard treatment. However, for patients unfit for or refusing surgery, intravesical Bacillus Calmette-Guérin (BCG) immunotherapy remains a commonly used bladder-preserving approach. This study aimed to assess oncological outcomes in patients with VHR NMIBC treated with intravesical BCG or ERC.
Methods: We conducted a retrospective cohort study, including patients with VHR NMIBC treated with BCG or ERC between July 2008 and May 2023. Data were collected from an institutional electronic database. Only patients who received adequate BCG treatment, according to predefined induction and early maintenance criteria, were included in the BCG group. We analyzed clinical and pathological features, overall survival (OS), and cancer‑specific survival (CSS). Secondary objectives included progression and high-grade intravesical recurrence rates among BCG-treated patients.
Results: Among 112 patients included, 99 received BCG and 13 underwent ERC. Patients undergoing ERC were younger and more frequently presented with adverse pathological features, including lymphovascular invasion and variant histology. No statistically significant differences in OS or CSS were observed between the groups. The estimated 60-month CSS was 91.1% in the BCG group and 100% in the ERC group. In the BCG cohort, 48 patients (48.5%) experienced recurrence and 15 progressed to muscle-invasive disease.
Conclusions: In this retrospective cohort of patients with VHR NMIBC, intravesical BCG was associated with acceptable oncological outcomes in selected cases. However, due to significant baseline imbalances and the small size of the ERC group, these findings should be interpreted with caution, and cannot be considered evidence of equivalence between treatment strategies. Further prospective multicenter studies are needed to refine patient selection and optimize treatment strategies in this population.
Article
Knowledge map
Save
Background: This study aimed to evaluate outcomes following a preoperative strategy in which invasive multichannel urodynamic testing guided the decision to perform concomitant Burch colposuspension during abdominal sacrocolpopexy. A secondary objective was to assess whether a non-invasive diagnostic test could predict urodynamic stress urinary incontinence (USUI) in patients with severe apical pelvic organ prolapse scheduled for abdominal sacrocolpopexy.
Methods: A retrospective review of medical records was performed for patients who underwent abdominal sacrocolpopexy. Patients with USUI underwent concomitant Burch colposuspension (Group 1), while those without underwent abdominal sacrocolpopexy alone (Group 2). Both groups were assessed for postoperative satisfaction, pre- and postoperative stress urinary incontinence status and changes in symptom questionnaire scores. In addition, non-invasive parameters were identified to predict the presence of USUI, as detected by multichannel urodynamic study across the entire cohort.
Results: Groups 1 and 2 consisted of 53 (48.6%) and 56 (51.4%) patients, respectively. The median follow-up time was 16 months (interquartile range: 12–21). Based on the Patient Global Impression of Improvement, satisfaction rates (defined as responses of “a little better” or greater) were 92.5% and 94.6% in Groups 1 and 2, respectively. Postoperative symptom questionnaire scores significantly improved in both groups; notably, postoperative stress urinary incontinence (SUI) status significantly improved only in Group 1 (p < 0.001). Multivariable logistic regression and modified Poisson regression analyses demonstrated that a positive provocative stress test with prolapse reduction was independently associated with USUI.
Conclusions: When preoperative multichannel urodynamic study identified USUI, combining abdominal sacrocolpopexy with Burch colposuspension yielded favorable surgical outcomes. Although the provocative stress test with prolapse reduction may serve as a screening tool for predicting preoperative USUI in patients with severe apical pelvic organ prolapse undergoing abdominal sacrocolpopexy, it cannot yet be considered a substitute for multichannel urodynamic study.
Article
Knowledge map
Save
Background: This study aimed to compare the effects of short-course (5–7 days) versus standard-course (10–14 days) antibiotics on the incidence and recurrence of renal cortical defects and urological management outcomes in neonates with urinary tract infection (UTI), particularly in those with underlying urinary malformations.
Methods: A retrospective analysis was conducted on 196 neonates with UTIs (98 in the short-course group and 98 in the standardcourse group) admitted to our centre between February 2021 and December 2024. The co-primary outcomes were the incidence of renal cortical defects on Technetium-99m dimercaptosuccinic acid (99mTc-DMSA) imaging at 6–12 months and 30-day UTI recurrence. Prespecified secondary outcomes included treatment-related indicators, short-term efficacy, renal function, safety and health-economic endpoints. Structural follow-up, urological referral, urological intervention and subgroup outcomes according to urinary malformation status were analysed as exploratory outcomes. Subsequently, 1:1 propensity score matching was performed to mitigate confounding by indication.
Results: The short-course group had a significantly shorter antibiotic duration and hospital stay, with lower total hospitalisation and antibiotic costs (all p < 0.001), than the standard-course group. 30-day UTI recurrence was higher in the short-course group than in the standard-course group, whereas the incidence of renal cortical defects at 6–12 months did not differ significantly. Structural follow-up and urological subgroup findings, particularly in neonates with urinary malformations, showed nominal between-group differences but were interpreted as exploratory after correction for multiple comparisons.
Conclusions: In this single-centre retrospective cohort study, short-course antibiotics yielded comparable renal cortical defect outcomes but a higher 30-day UTI recurrence rate compared with standard-course antibiotics in neonates with UTIs. Shortcourse therapy was associated with shorter hospitalisation and lower overall costs than standard-course therapy. Structural and urological follow-up findings, particularly in neonates with urinary malformations, should be interpreted as exploratory and require prospective validation.
Article
Knowledge map
Save
Background: This study aimed to develop a nomogram integrating multiparametric magnetic resonance imaging (mpMRI) features and clinical indicators for the preoperative prediction of positive surgical margins (PSM) after radical prostatectomy (RP).
Methods: This retrospective study enrolled 304 patients who underwent RP for prostate cancer (PCa). The patients were divided into PSM (n = 98) and negative surgical margin (NSM, n = 206) groups based on histopathological results. Preoperative clinical variables, including prostate-specific antigen (PSA), PSA density (PSAD), biopsy Gleason Grade Group and clinical T-stage, were collected. The mpMRI parameters assessed included Prostate Imaging Reporting and Data System (PI-RADS) v2.1 score, tumour location, extracapsular extension (ECE), tumour maximum diameter, capsule contact length (CCL) and apparent diffusion coefficient (ADC) value.
Results: Compared with the NSM group, the PSM group had significantly higher preoperative PSA, higher PSAD, a higher proportion of biopsy Gleason Grade Group 4–5, and a higher clinical T-stage proportion. On mpMRI, the PSM group exhibited a higher proportion of PI-RADS v2.1 score 5 lesions, more frequent transition zone tumours, higher suspicion of ECE, larger tumour maximum diameter, longer CCL and lower ADC value. Multivariate analysis identified PSAD, PI-RADS v2.1 score, suspected ECE, tumour maximum diameter, CCL, ADC value, and biopsy Gleason Grade Group as independent predictors of PSM (all p < 0.05). The nomogram achieved an area under the curve of 0.907 (95% confidence interval (CI): 0.873–0.941).
Article
Knowledge map
Save
Background: The study aimed to evaluate the use decision support analysis for the prediction of extracorporeal shock wave lithotripsy (ESWL) efficacy and to analyze the factors influencing outcomes in patients who underwent ESWL using machine learning (ML) methods.
Methods: This retrospective study analyzed the clinical data, including preoperative computed tomography (CT) images, of 302 patients who received a single ESWL session treatment for urinary stone between May and October 2022 in the Department of Urology. The data was preprocessed and incorporated into an ML model, and the dataset was validated at a ratio of 4:1. The area under the curve (AUC) and the confusion matrix were used to evaluate the predictive efficacy of the model.
Results: The CT image-based ML model predicting ESWL efficacy for urinary stone removal achieved an AUC of 0.86, precision of 88.33%, F1 score of 86.57%, sensitivity of 82.86%, and specificity of 88.89%. The model achieved an AUC of 0.95 for kidney stones, with 95.45% precision, 96.00% F1 score, 100.00% sensitivity, and 90.00% specificity. The AUC value for upper ureteral stones was 0.89, with 89.14% precision, 88.05% F1 score, 83.33% sensitivity, and 94.51% specificity, while that for mid-ureteral stones was 0.85, with 82.93% precision, 84.09% F1 score, 74.00% sensitivity, and 96.88% specificity, and the success rate of ESWL for lower ureteral stones was 100.00%, with an AUC of 1.00.
Article
Knowledge map
Save
Background: This study aimed to investigate the significance of integrating multiparametric magnetic resonance imaging (mpMRI) assessment with proactive nursing care for patients undergoing radical prostatectomy for prostate cancer.
Methods: A retrospective cohort study was conducted, collecting clinical data from 130 patients who underwent radical prostatectomy for prostate cancer in the Department of Urology of the Affiliated Hospital 2 of Nantong University from June 2023 to October 2025. Patients were divided into a study group (n = 65) and a control group (n = 65) based on perioperative nursing care protocols. The control group underwent routine perioperative nursing care in the urology department, whereas the study group received mp-MRI assessment combined with proactive nursing guidance and routine care. The urinary continence recovery rate, urodynamic parameters, nursing compliance and complication rate at different postoperative time points were compared between the two groups.
Results: At 6 months postoperative follow-up, the total urinary continence rate (complete + social continence) and the absence of severe incontinence in the study group were significantly higher than those in the control group (p < 0.05), with statistically significant differences between the groups (p < 0.05). Repeated-measures analysis of variance (ANOVA) confirmed significant group effects for all urodynamic parameters, with comparable recovery trajectories between the groups, except for residual urine volume.
Conclusions: In this retrospective cohort study, an enhanced nursing programme based on mp-MRI assessment was associated with improved urinary continence recovery and urodynamic parameters in patients undergoing radical prostatectomy. However, these findings require confirmation in prospective randomised controlled trials.
Article
Knowledge map
Save
Objective: To evaluate whether an evidence-based pain management and rehabilitation nursing pathway improves early recovery after mini-percutaneous nephrolithotomy (mini-PCNL) for complex renal or ureteral stones.
Methods: This retrospective cohort study included 148 patients undergoing mini-PCNL from January 2023 to December 2025. The control group received routine perioperative nursing care (January 2023–June 2024), and the observation group received an evidence-based pain and rehabilitation nursing pathway (July 2024–December 2025), with 74 patients in each group. Stress indicators, pain, renal function, recovery milestones, and complications were compared.
Results: Heart rate and mean arterial pressure changed over time, but did not differ between-group. Compared with the control group, the observation group had lower cortisol levels at 6 h (888.5 ± 159.3 vs 1074.1 ± 258.2 nmol/L) and 24 h postoperatively (522.7 ± 97.5 vs 868.0 ± 215.9 nmol/L), and lower adrenocorticotropic hormone levels at 6 h (20.7 ± 5.4 vs 26.9 ± 7.6 pmol/L) and 24 h postoperatively (12.6 ± 3.5 vs 21.4 ± 6.2 pmol/L). Median Visual Analogue Scale (VAS) pain scores were lower at 6, 12, and 24 h postoperatively (5, 4, 3 vs 7, 6, 5). At 24 h postoperatively, serum creatinine (87.5 ± 14.7 vs 96.4 ± 15.0 µmol/L) and blood urea nitrogen levels (5.59 ± 0.94 vs 6.36 ± 1.34 mmol/L) were lower. The observation group also had earlier first ambulation (13.3 vs 15.4 h), lower VAS scores at first voiding (3 vs 5), and shorter hospital stay (4 vs 6 days). Nephrostomy tube duration, catheter duration, urinary tract infection, and haematuria were similar.
Conclusions: Evidence-based pain management and rehabilitation nursing was associated with reduced early biochemical stress markers, improved pain control and short-term renal function, and accelerated early recovery after mini-PCNL.
Article
Knowledge map
Save
Background: Early confirmation of urogenital tuberculosis(UGTB) remains challenging in routine practice because conventional culture is slow and has variable sensitivity. Urine-based molecular testing has emerged as a rapid alternative, but its performance estimates vary across studies. This systematic review evaluated the diagnostic value of urine-based molecular testing, including Xpert Mycobacterium tuberculosis/rifampicin, multiplex polymerase chain reaction and loop-mediated isothermal amplification, for UGTB.
Methods: Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) were generated with a bivariate randomeffects model. The summary receiver operating characteristic (SROC) curve and Fagan nomogram were used for visualization.
Results: A total of 14 diagnostic accuracy studies, comprising 1697 patients with high clinical suspicion of UGTB, were analysed. Pooled sensitivity was 0.748 (95% confidence interval [CI]: 0.566–0.871), pooled specificity was 0.962 (95% CI: 0.932–0.979), pooled DOR was 121.77 (95% CI: 37.86–391.68), and the area under the SROC curve was 0.93. Studies using bacterial culture as the reference standard yielded a pooled specificity of 1.000, whereas those using a composite reference standard yielded a pooled specificity of 0.934. With a 20% pre-test probability, a positive test increased the post-test probability to 83%, while a negative test lowered it to 6%.
Conclusions: Urine-based molecular testing shows high diagnostic accuracy and clinical utility for UGTB. It may serve as an adjunctive test for early rapid confirmation, especially when interpreted alongside clinical, imaging and culture findings. The PROSPERO Registration: The study was registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420261373256; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261373256).
Article
Knowledge map
Save
Objective: To evaluate the efficacy and safety of Xia Li Qi capsules (XLQ) for benign prostatic hyperplasia (BPH) and explore its mechanisms of action involving the p38-Janus kinase/signal transducer and activator of transcription (p38-JAK/STAT) pathway.
Methods: In this randomised controlled trial, 115 patients with BPH received XLQ (n = 58) or placebo (n = 57) for 8 weeks. The primary endpoint was change in International Prostate Symptom Score (IPSS) from baseline to Week 8; secondary endpoints included the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), maximum urinary flow rate (Qmax), mean urinary flow rate (Qave), prostate volume, post-void residual urine volume, quality of life (QOL), and the International Index of Erectile Function-5 (IIEF-5). Baseline-adjusted analysis of covariance (ANCOVA) was performed for between-group comparisons. In vitro, experiments using BPH-1 cells were conducted to assess cell proliferation, inflammatory cytokines levels, androgen receptor (AR)-related genes, and p38–JAK1–STAT3 signalling.
Results: Both groups showed significant improvements in IPSS, NIH-CPSI, Qmax, Qave, and QOL (all p < 0.001). No significant between-group differences in IPSS or NIH-CPSI after adjustment. At Week 8, Qmax and Qave were significantly higher in the XLQ group (both p < 0.001), with reduced residual urine volume (p = 0.010). QOL improvement favoured XLQ before correction (p = 0.018) but did not survive multiple-comparison correction; prostate volume and IIEF-5 were unchanged. In vitro, XLQ inhibited BPH-1 proliferation, reduced interleukin (IL)-6, IL-1β, and tumour necrosis factor-α (TNF-α), suppressed AR-related gene expression, and decreased the phosphorylation of p38, JAK1, and STAT3 phosphorylation; these effects were partially reversed by p38 activation.
Conclusions: XLQ improves urinary function in BPH patients, potentially by the inhibiting of inflammation and AR signalling via the p38-JAK/STAT axis.
Clinical Trial Registration: The study was registered at Clinicaltrial.gov (https://www.chictr.org.cn/showproj.html?proj=14405), registration number: (ChiCTR1900022393).
Article
Knowledge map
Save
Background: Accurate preoperative estimation of tumour grade may guide management decisions for clear cell renal cell carcinoma (ccRCC); however, grade is typically confirmed only postoperatively. This study evaluated whether an internally validated proof-of-concept model combining the systemic immune-inflammation index (SII) with multiphasic computed tomography (CT) features could identify high Fuhrman grade preoperatively, while acknowledging that this endpoint is not interchangeable with World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade without revalidation.
Methods: This study retrospectively analysed 286 surgically treated patients with pathologically proven ccRCC between January 2018 and December 2023. Patients were randomly assigned to training (n = 200) and internal validation (n = 86) cohorts. SII was calculated from preoperative platelet, neutrophil, and lymphocyte counts and modelled continuously; the SII cutoff of 530 was used only for sensitivity analysis and nomogram display. Variables with p < 0.10 in univariable logistic regression and variables considered clinically important were entered into multivariable logistic regression with backward stepwise selection. Collinearity diagnostics, area under the curve (AUC) comparison, calibration, decision curve analysis, bootstrap resampling, and risk stratification were performed.
Results: High-grade ccRCC (Fuhrman III/IV) accounted for 31.1% of cases. In multivariable analysis, continuous SII (odds ratio (OR) = 1.39 per 100-unit increase, 95% confidence interval (CI): 1.18–1.63, p < 0.001), tumour size >4 cm (OR = 3.06, 95% CI: 1.44–6.52, p = 0.004), intratumoral necrosis (OR = 4.71, 95% CI: 2.26–9.83, p < 0.001), and corticomedullary phase (CMP) enhancement ≤84 Hounsfield unit (HU; OR = 2.11, 95% CI: 1.10–4.04, p = 0.024) were independently associated with high-grade disease. The nomogram achieved AUCs of 0.891 (95% CI: 0.846–0.936) and 0.867 (95% CI: 0.793–0.941) in the training and validation cohorts. Adding SII to CT features improved the validation AUC by 0.036 and improved reclassification metrics.
Conclusions: This internally validated proof-of-concept nomogram integrates continuous SII and routine enhanced CT features to estimate the probability of high Fuhrman grade in surgically treated ccRCC. It may facilitate preoperative discussions in similar clinical settings, but external validation using centralized WHO/ISUP grading is required before broad implementation.
Article
Knowledge map
Save
Background: Prostate cancer (PCa), bladder cancer (BCa), and kidney cancer (KC) are the predominant urological cancers in older adults, posing substantial global health burdens. This study aimed to identify regions with the most rapid growth in combined urological cancer burden and characterize their distinct epidemiological profiles, risk factor attributions, and future trajectories.
Methods: We aggregated age-standardized incidence rates (ASIRs) for PCa, BCa, and KC across 21 Global Burden of Disease (GBD) regions (1990–2021), identifying six high-growth regions using the estimated annual percentage change (EAPC) of the combined ASIR. We analysed mortality-to-incidence ratios (MIRs), risk factor-attributable mortality, disability-adjusted life year (DALY) decomposition, and autoregressive integrated moving average (ARIMA) projections to 2036. DALYs were further decomposed into years of life lost (YLLs) and years lived with disability (YLDs).
Results: Six high-growth regions were identified: Eastern Europe, Central Europe, North Africa and Middle East (NAME), High-income Asia Pacific (HIAP), Southeast Asia (SEA), and Andean Latin America (ALA). High body mass index (BMI) has surpassed tobacco as the leading attributable risk factor for KC mortality globally (2021 male age-standardized mortality rate [ASMR] in Eastern Europe: 2.91 [95% uncertainty interval (UI): 2.07–3.74] vs. 1.88 [1.15–2.62] per 100,000 for tobacco). Tobacco use remains the leading attributable risk factor for BCa mortality, though declining in most regions, except Central European women (EAPC 1.23 [0.78–1.69]). Eastern and Central Europe showed the steepest increases in PCa DALY rates (Central Europe: from 145.54 to 301.56 per 100,000). Decomposition analyses revealed that epidemiological changes were associated with burden increases in high-human development index (HDI) regions, whereas population growth and aging predominated in NAME, SEA, and ALA. ARIMA projections indicate rising PCa incidence and mortality in Eastern Europe through 2036.
Conclusions: Eastern and Central Europe require urgent, evidence-based interventions targeting rapid disease burden growth and high baseline rates. Low-to-middle HDI regions should implement proactive policies to reduce future risks driven by demographic transitions and the adoption of westernized lifestyle.
Article
Knowledge map
Save
Background: Gross haematuria constitutes a life-threatening complication of urologic tumours, demanding urgent and precise identification of the responsible bleeding vessels, along with immediate and effective haemostatic intervention to avert hemodynamic collapse.
Methods: This retrospective cohort study included 120 emergency patients with urologic tumours and gross haematuria between January 2020 and December 2023. All patients underwent preprocedural computed tomography angiography (CTA) to evaluation bleeding vessels and tumour blood supply, followed by transarterial embolization (TAE). Clinical characteristics, procedural outcomes, and follow-up data were analysed.
Results: Preprocedural CTA identified target vessels in 112 of 120 patients (93.3%). Postoperative complications occurred in 23 patients (19.2%) and were predominantly Clavien–Dindo grade I–II, including embolization syndrome (9.2%), transient recurrent haematuria (5.0%), and urinary tract infection (3.3%), all of which were managed conservatively. Multivariate Cox regression analysis identified tumour node metastasis (TNM) stage III–IV, multiple tumour foci, and hypovascular supply as independent risk factors for haematuria recurrence and poor overall survival rate (all p < 0.05).
Conclusions: CTA-assisted TAE shows high immediate haemostatic efficacy and acceptable short-term safety, supporting its clinical feasibility as a rescue approach for urologic tumour-related gross haematuria. TNM stage III–IV, multiple foci, and hypovascular supply predict poorer outcomes. Prospective multicentre controlled studies are warranted.
Article
Knowledge map
Save
Background: To systematically compare general anaesthesia (GA) and regional anaesthesia in patient undergoing minimally invasive surgery for urinary calculi, focusing on operative outcomes (e.g., operative time, length of hospital stay, stone-free rate [SFR]) and early postoperative outcomes (e.g., pain measured by the visual analog scale [VAS] and complication rate), and to provide evidence to guide anaesthetic selection.
Methods: PubMed, Embase, and the Cochrane Library were searched from database inception to December 2025 for randomized controlled trials (RCTs) comparing GA with regional anaesthesia in minimally invasive urinary stone procedures. Study quality was assessed using the Cochrane Risk of Bias tool. Meta-analyses were conducted using RevMan 5.4. Heterogeneity was quantified using the I 2 statistic; fixed-effects models were used when I 2 < 50% and random-effects models when I 2 ≥ 50%. Sensitivity analyses were conducted to evaluate the robustness of pooled estimates. The analysis included seven RCTs (525 participants) with regional anaesthesia administered to n = 257 and GA to n = 268.
Results: Regional anaesthesia was associated with a shorter operative time compared with GA (weighted mean difference [WMD] = –8.90 minutes, 95% confidence interval [CI] = –14.53 to –3.27; p = 0.002). After excluding studies that contributed to heterogeneity, the effect remained consistent (I 2= 43%; p = 0.004). No statistically significant between-group differences were observed for length of hospital stay or SFR (p > 0.05). In the primary analyses, postoperative 4–8 hours VAS scores and complication rates showed no significant differences (p > 0.05). Sensitivity analyses suggested that, after exclusion of influential studies, regional anaesthesia was associated with higher VAS scores (WMD = 1.11, 95% CI: 0.59 to 1.64; p < 0.001), and one sensitivity model suggested a higher complication rate in the regional anaesthesia group (odds ratio [OR] = 2.79, 95% CI = 1.49 to 5.20; p = 0.001). Risk-of-bias assessment varied across domains, with concerns mainly related to performance bias and incomplete reporting in some trials.
Conclusions: Regional anaesthesia may shorten overall procedure-related time in minimally invasive surgery for urinary calculi. However, its effects on postoperative pain and complications remain uncertain, and the complication outcome was sensitive to individual studies. Length of hospital stay and SFR do not appear to substantially differ between anaesthesia strategies. The PROSPERO Registration: The protocol for this meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420261326142, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261326142).
Article
Knowledge map
Save
Background: This study aimed to investigate the incidence and risk factors of urosepsis following laparoscopic urological surgery, develop a predictive nomogram, and evaluate the association between postoperative urosepsis and acute kidney injury (AKI).
Methods: This retrospective analysis was performed on 426 consecutive patients who underwent laparoscopic urological surgery between March 2020 and August 2025. Patients were divided into a sepsis group (n = 42) and a non-sepsis group (n = 384) based on the occurrence of postoperative urosepsis. Demographics, disease and surgical characteristics, laboratory parameters, and the incidence of AKI were compared between the two group. Independent risk factors were identified using multivariable logistic regression and incorporated into a predictive nomogram. Model performance was assessed by receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA).
Results: Postoperative urosepsis occurred in 9.86% (42/426) of patients, of whom 83.33% (35/42) had positive urine cultures. Independent risk factors included positive preoperative urine culture, prolonged operative time, elevated urinary heparin-binding protein (HBP), and elevated white blood cell (WBC) count (all p < 0.05). The nomogram achieved an area under the ROC curve of 0.812 (95% confidence interval [CI]: 0.739–0.885), sensitivity of 0.810, specificity of 0.677, accuracy of 0.690, good calibration (Hosmer–Lemeshow test, p = 0.388), and net clinical benefit on DCA. The incidence of AKI was higher in the sepsis group than in the non-sepsis group (30.95% vs. 6.25%, p < 0.05), with greater severity observed in the sepsis group. After adjustment for age, diabetes mellitus, intraoperative blood loss, and baseline creatinine, urosepsis remained an independent risk factor for AKI (odds ratio [OR] = 5.623, 95% CI: 2.847–11.106; p < 0.05).
Conclusions: Urosepsis after laparoscopic urological surgery is an independent risk factor for AKI. The developed nomogram, incorporating preoperative urine culture, operative time, urinary HBP, and WBC count, demonstrated good performance in identifying patients at high risk of postoperative urosepsis.
Article
Knowledge map
Save
Background: This study aimed to investigate the diagnostic value of the C-reactive protein/albumin ratio (CAR) and platelet/albumin ratio (PAR) combined with prostate-specific antigen (PSA)-derived indicators for prostate cancer (PCa) and to develop a visualised nomogram for PCa diagnosis.
Methods: This retrospective study included 354 patients undergoing initial prostate biopsy between January 2023 and December 2025. Patients were randomly assigned to a training set (n = 248, 70%) and a validation set (n = 106, 30%). The training set included 106 patients with PCa and 142 patients with benign prostatic hyperplasia (BPH). Clinical characteristics and laboratory data were collected to calculate CAR, PAR and PSA-derived indicators. Independent risk factors of PCa were identified using univariate and multivariate logistic regression analyses and incorporated into a nomogram. Model performance was assessed by receiver operating characteristic (ROC) curves, calibration curves, bootstrap internal validation (1000 resamples) and decision curve analysis (DCA).
Results: Compared with patients with BPH, those with PCa had older age, lower free/total prostate-specific antigen ratio (f/tPSA), and higher prostate-specific antigen density (PSAD), CAR and PAR (all p < 0.05). Multivariate analysis confirmed these five indicators as independent predictors of PCa (all p < 0.05). The combined model yielded an area under the curve (AUC) of 0.882, significantly outperforming single indicators (p < 0.05), with a sensitivity of 92.45% and a specificity of 73.94%. The nomogram achieved AUCs of 0.886 (training) and 0.850 (validation), with an AUC difference of 0.036 and no significant overfitting. Patients with intermediate- to high-risk PCa (Gleason score ≥ 7) showed lower f/tPSA and higher PSAD, CAR, PAR than those with low-risk PCa (all p < 0.05). Calibration curves showed good agreement between predicted and actual observed probabilities, and DCA indicated favourable clinical net benefit.
Conclusions: Age, f/tPSA, PSAD, CAR and PAR are independent risk factors of PCa. Internal validation of the nomogram incorporating these variables showed no significant overfitting and high preoperative diagnostic value. The nomogram may assist in tumour malignancy assessment, but external multicentre validation is needed to confirm its generalisability.
Article
Knowledge map
Save
Introduction: Urothelial carcinoma (UC) with clear cell subtype is a malignant neoplasm characterized by a distinctive morphological pattern featuring a glycogen-rich cytoplasm. Due to its extremely rare occurrence in the upper urinary tract, an optimal treatment has not yet been established.
Case Presentation: This study reports the case of an 81-year-old woman diagnosed with upper tract urothelial carcinoma (UTUC) with clear cell subtype located in the right renal pelvis. The patient underwent laparoscopic radical nephroureterectomy, and pathological findings showed that clear-cell morphology accounted for more than 90% of the tumor. Gemcitabine and carboplatin were administered as adjuvant chemotherapy. However, 3 months after completing adjuvant chemotherapy, the patient developed severe pain, and imaging examinations revealed metastasis to the para-aortic lymph nodes and retroperitoneum. Subsequently, the patient underwent systemic therapy with enfortumab vedotin (EV) and pembrolizumab (EV-P). Following a single cycle of EV-P, the patient exhibited substantial improvement in symptoms, and metastatic lesions decreased notably. Immunohistochemical testing confirmed strong expression of Nectin-4 in the tumor tissue.
Conclusions: This is the first report to demonstrate the efficacy of EV-P for recurrent UTUC with clear cell subtype. In tumors exhibiting rare histological variants, the identification of biomarkers such as nectin-4 suggests their potential to guide effective treatment selections.
