Urology最新文献

英文中文

Ultrasound Diagnostic Features and Management of Torsion-detorsion 扭转-扭转的超声诊断特点及处理。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2025-12-04 DOI: 10.1016/j.urology.2025.11.254

Olamide Olawoyin, Ankur U. Choksi, Benjamin H. Press, Nishan Sohoni, Robert M. Weiss, Angela M. Arlen

Objective

To identify ultrasound predictors of those at risk of testicular loss in patients who underwent immediate scrotal exploration in the setting of torsion-detorsion (TDS) diagnosis.

Methods

Retrospectively reviewed patients with concerns for testicular torsion between 2015 and 2023. Patients with history or ultrasound findings described by radiologists suggestive of TDS were analyzed. Patient demographics, duration of pain and surgery, ultrasound and intraoperative findings as well as perioperative outcomes were assessed.

Results

One hundred sixty-nine patients who underwent scrotal exploration for acute testicular pain were identified, 47 met inclusion criteria for TDS. All patients underwent scrotal exploration and bilateral testicular fixation. All testes were salvaged, and no orchiectomies were performed. Average time from onset of pain to urologic evaluation was 18.3 hours. Median TWIST score was 4. The most common ultrasound finding was twisting or swirl in the spermatic cord which was described in 28/47 patients. Asymmetric blood flow, in comparison to the contralateral testicle was reported in 19/47 patients. Hyperemia in 4/47 patients. Ultrasound finding of spermatic cord swirling was the most common correlate with the intraoperative finding of testicular torsion (at least 180 degrees twisting or congestion of the spermatic cord) in 17/26 patients.

Conclusion

Twisting in the spermatic cord was the most common ultrasound description with a positive predictive value (PPV) of 65.4%. Ultrasound findings correlated with intraoperative findings with a PPV of 68.4%. Findings of twisting of the spermatic cord or asymmetric blood flow even in the presence of blood flow are a reasonable indication for scrotal exploration.

目的：探讨在TDS诊断下立即行阴囊探查的患者有睾丸丢失危险的超声预测因素。方法：回顾性分析2015 ~ 2023年因睾丸扭转就诊的患者。分析放射科医生描述的有TDS病史或超声表现的患者。评估患者人口统计学、疼痛和手术持续时间、超声和术中发现以及围手术期结果。结果：169例急性睾丸痛患者行阴囊探查，47例符合TDS纳入标准。所有患者均行阴囊探查及双侧睾丸固定。所有睾丸均保存，未行睾丸切除术。从疼痛发作到泌尿系统评估的平均时间为18.3小时。TWIST评分中位数为4分。47例患者中有28例超声表现为精索扭曲或旋流。与对侧睾丸相比，47例患者中有19例报告血流量不对称。4/47例患者充血。在17/26例患者中，超声发现精索旋转与术中发现睾丸扭转（至少180度扭转或精索充血）最常见。结论：精索扭转是最常见的超声表现，阳性预测值（PPV）为65.4%。超声表现与术中表现的相关性为68.4%。发现精索扭曲或血流不对称，即使在有血流的情况下，也是阴囊探查的合理指示。

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引用次数: 0

Editorial Comment on “Stent-associated Symptoms After Two-stage Ureteroscopy: Results From STENTS” 对“两期输尿管镜检查后支架相关症状：支架的结果”的评论。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2025-12-05 DOI: 10.1016/j.urology.2025.11.241

Ahmet Cihan

引用次数: 0

Editorial Comment on “Microscopic Spermatic Cord Denervation for Chronic Scrotal Content Pain Following Inguinal Hernia Repair: Outcomes and Predictors of Success” 《显微精索去神经术治疗腹股沟疝修补术后慢性阴囊内容物疼痛：结果和成功的预测因素》的社论评论。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.urology.2025.12.025

Sergey Kravchick

引用次数: 0

Variability in Cystatin C- and Creatinine-estimated Glomerular Filtration Rate in Adults With Spina Bifida 成人脊柱裂患者胱抑素C和肌酐估计GFR的变异性。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2025-12-19 DOI: 10.1016/j.urology.2025.12.012

Stephen Kisty , Sarah A. Korth , Blaise W. Abramovitz , Oluwasanmi Adenaiye , Paul Rusilko , Brad E. Dicianno

Objective

To determine if serum cystatin C, which does not depend on muscle mass, is a potential alternative measure of kidney function in individuals with Spina Bifida and lower urinary tract dysfunction. Assessment using serum creatinine to estimate glomerular filtration rate is often compromised in this population because of decreased muscle mass from paralysis, which varies over spinal lesion levels and sub-phenotypes. We hypothesized creatinine-based formulas overestimate glomerular filtration rate at higher lesion levels relative to cystatin C-based formulas, and cystatin C-based equations provide stable estimates.

Methods

We retrospectively analyzed data from 155 adults with Spina Bifida. Estimated glomerular filtration rates from 5 equations (Cr-eGFR-2009, Cr-eGFR-2021, CysC-eGFR-2012, Zappitelli-CysC-eGFR, and CrCysC-eGFR-2021) were compared across 5 lesion levels and 2 Spina Bifida sub-phenotypes (myelomeningocele vs non-myelomeningocele).

Results

Creatinine-based estimated glomerular filtration rate increased with higher lesion levels (both P <.001), overestimating kidney function by a median of 12 mL/min/1.73 m² in thoracic-level myelomeningocele compared with cystatin C estimates. All 3 cystatin C-based formulas were stable across lesion levels (P >.39) and highly correlated (ρ = 0.84-0.94); P30 exceeded 90% for every pair. We identified biases up to ±7.8 mL/min/1.73 m² and limits of agreement wider than ±40 mL/min/1.73 m².

Conclusion

Significant discrepancies were observed among creatinine-based equations, which consistently estimated kidney function to be higher at higher lesion levels (relative to cystatin C) and in myelomeningocele. Cystatin C-based estimates were stable regardless of lesion level. However, clinicians should be cautious about the interchangeability of cystatin C-based estimates.

目的：确定血清胱抑素C（不依赖于肌肉质量）是否可作为脊柱裂和下尿路功能障碍患者肾功能的潜在替代指标。使用血清肌酐来评估肾小球滤过率在这一人群中经常受到损害，因为瘫痪导致肌肉质量减少，这因脊髓病变水平和亚表型而异。我们假设基于肌酐的公式相对于基于胱抑素c的公式高估了较高病变水平下的肾小球滤过率，而基于胱抑素c的公式提供了稳定的估计。方法：回顾性分析155例成人脊柱裂患者的资料。通过五个方程（Cr-eGFR-2009、Cr-eGFR-2021、CysC-eGFR-2012、Zappitelli-CysC-eGFR、CrCysC-eGFR-2021）估算的肾小球滤过率在五个病变水平和两种脊柱裂亚表型（脊髓脊膜膨出与非脊髓脊膜膨出）中进行了比较。结果：基于肌酐的肾小球滤过率估计值随着病变水平的升高而升高（p均< 0.001），与胱抑素C估计值相比，胸段脊髓脊膜膨出的肾功能高估中位数为12 mL/min/1.73 m²。所有三个基于胱抑素c的公式在病变水平上都是稳定的（p < 0.39），并且高度相关（ρ = 0.84-0.94）；每对P30均超过90%。我们发现偏差高达±7.8 mL/min/1.73 m²，一致性范围大于±40 mL/min/1.73 m²。结论：在基于肌酐的方程中观察到显著的差异，这些方程一致地估计在较高的病变水平（相对于胱抑素C）和脊髓脊膜膨出时肾功能较高。无论病变程度如何，基于胱抑素c的估计都是稳定的。然而，临床医生应该对基于胱抑素c的估计的互换性持谨慎态度。

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引用次数: 0

Editorial Comment on “Management of Accidentally Contaminated Buccal Mucosa Grafts” “意外污染颊粘膜移植物的处理”社论评论。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2026-01-08 DOI: 10.1016/j.urology.2025.12.043

Jennifer A. Kane, Joseph Y. Clark

引用次数: 0

Editorial Comment on “Time Dependent Material Fatigue of the Artificial Urinary Sphincter Pressure-regulating Balloon: A Mechanical and Microscopic Analysis” “人工尿括约肌压力调节球囊材料疲劳的时间依赖性：力学和显微分析”的评论。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2026-01-13 DOI: 10.1016/j.urology.2026.01.012

Mei Tuong

引用次数: 0

Reply to Letter to the Editor on “Cannabis Use is Associated With Lower Urinary Tract Symptoms in Pediatric Patients – A Large Claims Database Study” 回复给编辑的关于“大麻使用与儿科患者下尿路症状有关——一项大型索赔数据库研究”的信。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2026-01-13 DOI: 10.1016/j.urology.2026.01.014

Aurora J. Grutman , Mohammad Elmojtaba Gumma , Nicole Page , Andrew T. Gabrielson , Marisa Clifton , Heather DiCarlo

引用次数: 0

Microscopic Spermatic Cord Denervation for Chronic Scrotal Content Pain Following Inguinal Hernia Repair: Outcomes and Predictors of Success 显微精索去神经治疗腹股沟疝修补后慢性阴囊内容物痛：结果和成功的预测因素。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2025-11-21 DOI: 10.1016/j.urology.2025.11.237

Makenna E. Romanelli , Bryan D. Naelitz , Raevti Bole , Neel V. Parekh , Daniel A. Shoskes , Scott D. Lundy , Sarah C. Vij

Objective

To characterize the effect of microscopic spermatic cord denervation (mSCD) on chronic scrotal content pain (CSCP) after inguinal hernia repair (IHR) and identify factors associated with pain resolution.

Methods

We conducted a retrospective chart review of patients who underwent mSCD for CSCP following IHR from January 2018 to June 2024 at a single academic medical center. Patient demographics, medical history, IHR surgical parameters, and postoperative self-reported pain assessments were collected. Patients were categorized as having complete, partial, or no resolution of pain. Univariate regression analysis was performed to identify predictors of pain resolution.

Results

Forty-two patients with CSCP following IHR who underwent mSCD were included. Five patients underwent bilateral mSCD, resulting in 47 cases for analysis. Pain resolved completely in 43% (n = 20/47) and improved in 87% (n = 41/47) of cases as assessed at a median follow-up time of 7 weeks (IQR: 6-14 weeks). No patient factors or IHR operative parameters were associated with complete pain resolution on univariate analysis. Patients who reported no improvement in pain (14%, n = 6/42) were younger (33 vs 58 years, P = .03) and more likely to have a history of levator tenderness/spasm (50 vs 7%, P = .02).

Conclusion

mSCD results in palliation of CSCP in most patients with prior IHR. mSCD may be less likely to benefit younger patients and those with a history of levator tenderness/spasm. General surgeons should consider urologic referral for mSCD in this patient population.

目的：观察显微精索去神经支配（mSCD）对腹股沟疝修补术后慢性阴囊内容物痛（CSCP）的影响，并探讨影响疼痛缓解的因素。方法：我们对2018年1月至2024年6月在单一学术医疗中心接受IHR后CSCP mSCD治疗的患者进行了回顾性图表回顾。收集患者人口统计资料、病史、IHR手术参数和术后自我报告的疼痛评估。患者分为疼痛完全缓解、部分缓解和无缓解。进行单变量回归分析以确定疼痛缓解的预测因子。结果：42例IHR后CSCP患者行mSCD。5例患者行双侧mSCD，共47例进行分析。在中位随访时间为7周（IQR: 6-14周）时评估，43% （n=20/47）的患者疼痛完全缓解，87% （n=41/47）的患者疼痛改善。在单因素分析中，没有患者因素或IHR手术参数与完全疼痛缓解相关。报告疼痛无改善的患者（14%,n=6/42）较年轻（33岁vs. 58岁，p=0.03），更有可能有提肌压痛/痉挛史（50比7%，p=0.02）。结论：mSCD可使大多数既往IHR患者的CSCP得到缓解。年轻患者和有提肌压痛/痉挛病史的患者可能较少受益于mSCD。普通外科医生应考虑在这类患者中进行mSCD的泌尿外科转诊。

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引用次数: 0

Automated Classification of Adverse Events After Hydrogel Perirectal Spacer Insertion for Prostate Cancer Using Large Language Models 大语言模型用于前列腺癌水凝胶直肠周围垫片插入后不良事件的自动分类。

IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.urology.2026.01.008

Nishan Sohoni , Nimit S. Sohoni , Ryan A. Sutherland , Vinaik M. Sundaresan , Shayan Smani , Prasanna Ananth , John A. Onofrey , Sanjay Aneja , Marcin Miszczyk , Ho-Joon Lee , Julia E. Olivieri , Michael S. Leapman

Objective

To examine the performance of large language models (LLMs) for the analysis of adverse events (AEs) associated with a perirectal hydrogel spacer (SpaceOAR) prior to prostate radiation.

Methods

We queried the Food and Drug Administration’s (FDA’s) Manufacturer and User Facility Device Experience (MAUDE) database to extract reports related to “SpaceOAR”. Ninety-seven reports were initially manually abstracted to classify the problems associated with each event, subsequent modifications in radiation timing, and severity using the Common Terminology Criteria for Adverse Events (CTCAE) score. We compared the accuracy of 3 families of LLMs when compared to human abstraction. The highest-performing LLM was then used to classify AEs based on all available MAUDE data for spaceOAR (n = 1455) from January 2015 to December 2024.

Results

The ability of LLMs to correctly identify the AE outcomes was aggregated into an overall score. The highest-performing model was GPT-4o, with an overall score of 4.96 (σ = 0.00526) compared to the human reviewers who had an overall score of 4.99 (σ =.216). When run on all 1455 reports, GPT-4o revealed that the most common primary problems were malpositioned gel (58.7%), infection/inflammation/abscess (10.4%), fistula (7.1%), and rectal ulcer (4.7%). ICU level care and death were reported 0.1% and 0.3% of the time, respectively.

Conclusion

These findings highlight the potential for LLMs to automate the time-consuming process of tabulating device-related AEs. Reported serious AEs associated with spaceOAR underscore potential safety concerns, warranting dynamic ongoing surveillance and careful consideration when opting to implement hydrogel spacers.

目的：研究大语言模型（LLMs）在前列腺放疗前与直肠周围水凝胶间隔剂（SpaceOAR）相关的不良事件（ae）分析中的表现。方法：我们查询美国食品药品监督管理局（FDA）的制造商和用户设施设备体验（MAUDE）数据库，提取与“SpaceOAR”相关的报告。使用不良事件通用术语标准（CTCAE）评分，97份报告最初被人工提取，以分类与每个事件相关的问题、随后的放疗时间修改和严重程度。我们比较了3个llm家族与人类抽象的准确性。然后，根据2015年1月至2024年12月期间space eoar （n = 1455）的所有可用MAUDE数据，使用性能最高的LLM对ae进行分类。结果：LLMs正确识别AE结果的能力被汇总成一个总分。表现最好的模型是gpt - 40，其总分为4.96 (σ = 0.00526)，而人类评论者的总分为4.99 （σ = 0.216）。在所有1455份报告中，gpt - 40显示最常见的主要问题是凝胶定位不当（58.7%），感染/炎症/脓肿（10.4%），瘘（7.1%）和直肠溃疡（4.7%）。ICU级别的护理和死亡分别为0.1%和0.3%。结论：这些发现突出了llm自动化设备相关ae制表耗时过程的潜力。据报道，与spacear相关的严重ae强调了潜在的安全问题，在选择使用水凝胶隔离剂时，需要进行动态持续监测和仔细考虑。

{"title":"Automated Classification of Adverse Events After Hydrogel Perirectal Spacer Insertion for Prostate Cancer Using Large Language Models","authors":"Nishan Sohoni , Nimit S. Sohoni , Ryan A. Sutherland , Vinaik M. Sundaresan , Shayan Smani , Prasanna Ananth , John A. Onofrey , Sanjay Aneja , Marcin Miszczyk , Ho-Joon Lee , Julia E. Olivieri , Michael S. Leapman","doi":"10.1016/j.urology.2026.01.008","DOIUrl":"10.1016/j.urology.2026.01.008","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the performance of large language models (LLMs) for the analysis of adverse events (AEs) associated with a perirectal hydrogel spacer (SpaceOAR) prior to prostate radiation.</div></div><div><h3>Methods</h3><div>We queried the Food and Drug Administration’s (FDA’s) Manufacturer and User Facility Device Experience (MAUDE) database to extract reports related to “SpaceOAR”. Ninety-seven reports were initially manually abstracted to classify the problems associated with each event, subsequent modifications in radiation timing, and severity using the Common Terminology Criteria for Adverse Events (CTCAE) score. We compared the accuracy of 3 families of LLMs when compared to human abstraction. The highest-performing LLM was then used to classify AEs based on all available MAUDE data for spaceOAR (n = 1455) from January 2015 to December 2024.</div></div><div><h3>Results</h3><div>The ability of LLMs to correctly identify the AE outcomes was aggregated into an overall score. The highest-performing model was GPT-4o, with an overall score of 4.96 (σ = 0.00526) compared to the human reviewers who had an overall score of 4.99 (σ =.216). When run on all 1455 reports, GPT-4o revealed that the most common primary problems were malpositioned gel (58.7%), infection/inflammation/abscess (10.4%), fistula (7.1%), and rectal ulcer (4.7%). ICU level care and death were reported 0.1% and 0.3% of the time, respectively.</div></div><div><h3>Conclusion</h3><div>These findings highlight the potential for LLMs to automate the time-consuming process of tabulating device-related AEs. Reported serious AEs associated with spaceOAR underscore potential safety concerns, warranting dynamic ongoing surveillance and careful consideration when opting to implement hydrogel spacers.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"209 ","pages":"Pages 18-24"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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IF 2 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2026-02-25 DOI: 10.1016/j.urology.2026.02.030

Pedro Z Padovani, Lucas B Vergamini, Bristol B Whiles, Maxton Thoman, Wilson R Molina

引用次数: 0

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