Therapeutic Advances in Urology最新文献

Background: Radical nephrectomy is a recommended treatment for localized renal cell carcinoma when partial nephrectomy is not feasible. This approach is typically applied to patients with a normal contralateral kidney and no preexisting chronic kidney disease (CKD).The primary concern with surgery is its potential long-term impact on renal function.

Objectives: To assess the risk of development of chronic kidney disease after radical nephrectomy.

Design and methods: This is a retrospective cohort study of patients with normal preoperative renal function and contralateral kidney who underwent radical nephrectomy for cancer. At the last follow-up, patients were categorized according to CKD-EPI guidelines as having normal renal function grades G1-2 or impaired renal function grade ⩾G3a. Univariable and multivariable Cox regression analyses were used to identify the significant risk factors for CKD-free survival.

Results: We included 135 patients, 49.1 SD 12.9 years old, 62 women (45.9%), and 73 men (54.1%). Preoperative weight was 81 SD 18 kg, and eGFR was 99.2 SD 19.2 mL/min/1.73 m². The last follow-up 32.8 SD 16.8 months later showed that 38 (28.1%) patients developed renal impairment. Univariable analysis showed that preoperatively age in years, age ⩾65, male gender, hypertension, Charlson Comorbidity score, cerebrovascular disease, low preoperative eGFR, serum creatinine, and baseline CKD EPI grade G2 were significant predictors of last follow-up renal impairment. Intraoperatively, anesthesia duration, surgery duration, and postoperatively, within the first 48 hours lower eGFR, creatinine, and CKD-EPI category G3-5 were significant risk factors predicting CKD. After exclusion of colinear risk factors, multivariable analysis, however, indicated that preoperative eGFR (p < 0.027), lower intraoperative nadir MAP (p = 0.006), and postoperative within 48-hour eGFR (p = 0.003) were independent predictors of CKD-free survival at the last follow-up.

Conclusion: Significant risk factors for renal impairment after radical nephrectomy were a decreased preoperative eGFR, intraoperative hypotension and, within 48h, postoperative eGFR. No other preoperative or intraoperative risk factor independently predicted CKD.

Background: Ureteral fibroepithelial polyps (FEPs) are rare. The management of multiple polyps presents unique challenges, particularly when combined with other variants. These complex cases warrant individualized surgical planning.

Objective: To characterize a distinct subset of complex ureteral FEPs defined by the triad of multiple annular stenosis, tortuous ureter, and multiple polyps-collectively termed "MASTUMP," and to investigate its clinical, pathological, genetic features, and management considerations.

Design: Single-center retrospective study.

Methods: This study included nine patients treated for complex ureteral polyps between December 2019 and October 2024. Inclusion criteria required the presence of multiple FEPs (⩾3), ureteral tortuosity, and annular stenosis (⩾50% luminal narrowing). Clinical characteristics, imaging findings, surgical details, histopathology, and whole-exome sequencing (WES) were collected. Surgical outcomes and follow-up data were analyzed.

Results: The cohort (77.7% male, mean age 35.1 ± 13.1 years) presented with bilateral (55.5%) or left-sided (44.4%) polyps, with a median lesion length of 4 (range 1-6) cm. All patients had a history of failed endoscopic or surgical management. According to the society of fetal urology grading system, hydronephrosis was classified as grade 1 in one case, grade 2 in three cases, grade 3 in four cases, and grade 4 in one case, with a mean anterior posterior diameter of 2.43 ± 0.88 cm. WES identified mutations in NRIP1 and TSC2 in two patients. Surgical management included segmental ureterectomy with reconstruction via ureteroureterostomy (two cases), pelvic flap (one case), lingual mucosal graft (one cases), and ileal ureter replacement (five cases). Over a median follow-up of 46.3 (range 11.5-75.4) months, no recurrences were observed.

Conclusion: MASTUMP syndrome represents a clinical entity within complex ureteral polyps, potentially associated with congenital anomalies of the kidney and urinary tract. Endoscopic treatment carries a high risk of recurrence and should be approached with caution. Surgical resection with individualized reconstructive strategies offers durable outcomes. Further genetic studies and multicenter validation are essential to refine diagnostic criteria and treatment strategies.

Background: Artificial intelligence (AI) and large language models (LLMs) are increasingly integrated into healthcare, yet their adoption in pediatric urology remains insufficiently explored. Pediatric urology, with its complex and rare conditions, may particularly benefit from AI-based innovations.

Objectives: This study aimed to assess pediatric urologists' awareness, usage patterns, and perceptions regarding AI and LLMs, while also identifying potential applications, barriers, and educational needs.

Design: A cross-sectional, descriptive survey was conducted among pediatric urologists.

Methods: Between May and July 2025, a 21-item questionnaire was distributed via professional networks and mailing lists. Items addressed demographics, knowledge of AI, frequency and purpose of AI and LLM use, perceived clinical and surgical applications, ethical concerns, and interest in AI training. Descriptive statistics were used for analysis.

Results: Of 368 invited pediatric urologists, 103 (28%) responded. Most reported moderate (35.0%) or low (29.1%) knowledge of AI, yet more than half (51.5%) used AI tools daily. LLMs had been used by 96.1% of participants, mainly for scientific writing (78.8%), language editing (54.5%), and text summarization (46.5%). Surgical simulation (46.6%), imaging-based strategy planning (40.8%), and preoperative planning (36.9%) were identified as promising clinical applications. Barriers included lack of trust (52.4%), ethical concerns (43.7%), and insufficient knowledge (35.0%). A strong interest in structured AI training was expressed by 81% of participants. Although responses were obtained from multiple countries, the majority of participants were based in Turkey, and the findings should be interpreted accordingly.

Conclusion: Pediatric urologists demonstrate substantial engagement with AI in academic work, while clinical integration is still limited. The findings highlight a strong demand for AI education and emphasize the need for regulatory clarity, ethical frameworks, and validated tools to enable safe and effective use of AI in pediatric urology.

Primary mucinous adenocarcinoma (PMAC) of the urethra is an exceptionally rare subtype of primary urethral carcinoma, with limited published data to guide diagnosis or treatment. Most literature consists of isolated case reports, and the non-specific presentation often delays diagnosis. This report presents two further cases and a review of the literature with a view to expand current understanding. We report two cases of PMAC. The first involves a 67-year-old male with progressive lower urinary tract symptoms initially treated as benign prostatic hyperplasia. Histology following a transurethral resection of the prostate revealed invasive mucinous adenocarcinoma with enteric features. He underwent radical prostatectomy, chemotherapy and radiotherapy for metastatic disease. The second case is a 52-year-old female with chronic urinary symptoms and a urethral mass initially misattributed to being from gynaecological origin. However, a biopsy later confirmed mucinous adenocarcinoma of the urethra. She underwent chemotherapy and radiotherapy, with partial response, but later developed further metastatic spread and is now undergoing palliative chemotherapy. PMAC is aggressive, often presents with non-specific urinary symptoms and lacks standardised diagnostic or treatment protocols. These cases highlight the importance of early detection through biopsies, immunohistochemical analysis and a multidisciplinary approach. Broader awareness and further reporting of cases are essential to develop evidence-based diagnostic and treatment guidelines for this rare malignancy.

Background: Contralateral recurrence of upper-tract urothelial carcinoma (UTUC) presents a clinical challenge, with limited evidence regarding optimal surgical management.

Objective: To compare oncological outcomes among patients with contralateral UTUC recurrence managed by second nephroureterectomy (NUR) or nephron-sparing surgery (NSS), relative to those undergoing primary NUR.

Design: A multicentre retrospective cohort study.

Methods: In this multicentre retrospective cohort, 3159 patients diagnosed with UTUC between 2018 and 2024 in the Taiwanese UTUC Registry were analysed. Patients undergoing curative-intent surgery were grouped as follows: unilateral UTUC treated with primary NUR; contralateral recurrence treated with a second NUR; and contralateral recurrence managed with nephron-sparing surgery (NSS; segmental ureterectomy or endoscopic ablation). NUR was performed via open, laparoscopic, or robotic-assisted approaches. Outcomes included overall survival (OS), cancer-specific survival (CSS) and bladder recurrence-free survival (BRFS). Propensity score-based overlap weighting adjusted for baseline differences.

Results: After adjustment, both second NUR and NSS achieved OS, CSS, and BRFS comparable to primary NUR. Tumour biology, including stage, lymphovascular invasion and multifocality, exerted greater prognostic impact than contralateral recurrence status or surgical modality. While the rarity of contralateral recurrence limited statistical power, particularly for CSS and in the NSS subgroup, the consistency of effect estimates supports the robustness of the observed trends.

Conclusion: In this multicentre real-world cohort, second NUR and NSS for contralateral UTUC recurrence demonstrated broadly comparable survival outcomes to primary NUR, though the limited number of NSS cases and corresponding statistical power preclude firm conclusions.

Digital twins, dynamic, patient-specific virtual replicas of physical systems are gaining momentum across various medical fields. Their capacity to simulate and predict biological behavior offers unprecedented opportunities for personalized care. While their utility has been demonstrated in oncology, their application in urology remains nascent, and there is still a significant gap in literature findings. This review explores the theoretical framework, current evidence, and future potential of digital twins technology in managing urological conditions such as urolithiasis, benign prostatic hyperplasia (BPH), and nonmuscle invasive bladder cancer. A narrative literature review, guided by SANRA criteria, was conducted using PubMed and Scopus databases to identify relevant studies on the application of digital twins in healthcare, with a focus on urology and related fields. Additional sources from AI, imaging, and computational modelling were incorporated to support technological and theoretical concepts. Real-world use cases and clinical scenarios were constructed to illustrate the conceptual application of digital twins in endourology. Although limited in number, preliminary studies have shown promising results in uro-oncology, particularly for prostate and renal cancers. No models have yet been developed for benign urological diseases. Hypothetical applications in endourology include personalized procedural planning, dynamic follow-up, prediction of obstruction or recurrence, and real-time intraoperative guidance. Integration of imaging, functional data, and AI algorithms could create continuously adaptive simulations to support decision-making and improve treatment outcomes. However, barriers such as data complexity, cost, lack of validation frameworks, and clinician trust persist. Digital twins hold transformative potential for the future of urology, promising to personalize care across diagnosis, treatment, and surveillance. While the path to clinical integration is challenged by technical, ethical, and infrastructural hurdles, collaborative efforts and real-world validation studies are critical to realizing their full potential in clinical practice.

Background: Cystitis glandularis (CG) is a chronic inflammatory condition of the bladder characterized by a high recurrence rate, imposing a substantial burden on patients. The mechanisms underlying recurrence remain unclear.

Objectives: This study aims to identify markers associated with CG recurrence and develop a predictive model for recurrence risk.

Design: Retrospective cohort study of patients with confirmed recurrence based on outpatient visits or readmissions were included in this study, which was subsequently divided into training and test set.

Methods: Patients diagnosed with CG from four hospitals between 2013 and 2023 were retrospectively included and followed for one year. Recurrence was defined as the appearance of new nonneoplastic lesions on cystoscopy after complete resection of the primary disease. A total of 161 patients were divided into a training set (n = 98) from XiangYa Hospital and a test set (n = 63) from Shaoyang Central Hospital, the Second Affiliated Hospital of South China University, and the First People's Hospital of Changde City. Cox regression analysis was performed in the training set to identify serological indicators associated with recurrence, which were further validated at the histological level by immunohistochemistry. A prognostic model was then constructed using LASSO regression, and its predictive performance was evaluated using receiver operating characteristic (ROC) curves. A nomogram was also developed for clinical application.

Results: Among 161 patients followed for 12 months, the recurrence rate was 49.6% (n = 80). Univariate and multivariate Cox regression analyses revealed that serological eosinophil and basophil counts were significantly associated with CG recurrence, with histological validation confirming their relevance. The LASSO-based risk model demonstrated good predictive ability, with an area under the ROC curve exceeding 0.75.

Conclusion: Serological indicators, specifically eosinophil and basophil counts, are closely linked to CG recurrence. A risk score model based on these markers was developed, providing effective prediction of recurrence in clinical practice.

Male infertility accounts for a substantial proportion of global infertility, yet its molecular basis remains incompletely defined. Emerging evidence implicates epigenetic dysregulation in impaired spermatogenesis and abnormal sperm function. We synthesize genomic, transcriptomic, and single-cell studies to clarify how DNA methylation, histone modifications, and noncoding RNAs contribute to oligoasthenozoospermia. We also appraise single-cell RNA sequencing, single-cell assay for transposase-accessible chromatin using sequencing, and integrative multi-omics for resolving cell-type and stage-specific regulation. These approaches resolve germ-cell lineages, map gene-regulatory networks, and link chromatin states with transcription across spermatogenesis. Finally, we discuss translational implications for diagnostics, biomarkers, and therapeutic strategies, including antioxidant regimens, varicocele management, and assisted reproductive technologies outcomes. In conclusion, integrating epigenetics with single-cell technologies has enhanced our understanding of male germ cell development and identified potential research directions to improve reproductive health.

Background: Urolithiasis is a prevalent urological condition with high recurrence rates. Increasing evidence links metabolic syndrome (MetS) and its components to urinary stone disease, but the relationship between MetS and stone recurrence, including the roles of stone composition, residual fragments, urinary biochemistry, and lifestyle factors, remains underexplored.

Objectives: To investigate the association between MetS components and urinary stone recurrence in a retrospective cohort, with emphasis on stone composition, surgical residual fragments, urinary biochemical parameters, and lifestyle factors.

Design: A single-center retrospective case-control study.

Methods: We enrolled 542 patients with urinary stones (2019-2020) and followed them for up to 5 years (median follow-up 48 months). Baseline demographic, metabolic, lifestyle, urinary biochemical, surgical, and stone composition data were collected. Kaplan-Meier and Cox regression analyses were used to evaluate recurrence-free survival and independent predictors of recurrence.

Results: During follow-up, 211 patients (39%) experienced recurrence. The prevalence of MetS was significantly higher in the recurrence group (46.9% vs 28.7%). Cox regression identified hypertension (hazard ratio (HR) 1.31, 95% CI 1.04-1.65), hyperglycemia (HR 1.29, 1.01-1.64), hypertriglyceridemia (HR 1.38, 1.08-1.77), and residual fragments (HR 1.89, 1.47-2.43) as independent predictors. Stone composition analysis revealed higher recurrence in uric acid (52.3%), struvite (59.3%), and cystine (63.6%) stones compared with calcium oxalate (34.0%). Adverse urinary profiles (low pH, hypocitraturia, hyperuricosuria) and lifestyle factors (low fluid intake, high salt, high animal protein) were also associated with recurrence. Kaplan-Meier analysis showed shorter recurrence-free survival in patients with MetS (log-rank p < 0.001).

Conclusion: MetS and its components are independently associated with a higher risk of urinary stone recurrence. Stone composition, residual fragments, urinary biochemistry, and lifestyle factors further modify recurrence risk. These findings underscore the importance of comprehensive risk stratification and metabolic management in patients with urolithiasis.

Trail registration: Not applicable.