World Journal of Urology最新文献

Introduction: This study aimed to compare the predictive value of preoperative midstream urine culture (PMUC), intraoperative renal pelvic urine culture (RPUC), and stone culture (SC) for postoperative urinary tract infections (UTIs) following percutaneous nephrolithotomy (PCNL).

Methods: We retrospectively analyzed 234 patients who underwent supine-PCNL between January 2020 and April 2025. UTI was diagnosed based on systemic inflammatory response syndrome criteria and elevated inflammatory markers. Demographic, peri-, intra- and post-operative data were compared between patients with and without UTI. Multivariate logistic regression identified independent predictors.

Results: UTI occurred in 14.1%(n = 33) of patients postoperatively, with 72.7% presenting with fever. Culture positivity rates were significantly higher in postoperative UTI-patients (PMUC = 27.3% vs. 7.5%, SC: 39.4% vs. 8.0% and RPUC: 30.3% vs. 6.0%; p < 0.001). In UTI-patients, only 15.2% of postoperative urine cultures obtained before antibiotic treatment showed bacterial growth, which was lower than intraoperative cultures. UTI was higher in female patients (60.6% vs. 39.4%) and in those with an ASA score of 3 (p = 0.001 and p = 0.020). Female gender (OR = 3.71, p = 0.004), ASA-3 score (OR = 5.13, p = 0.029), positive SC (OR = 5.83, p = 0.001), and RPUC (OR = 3.67, p = 0.023) were independent predictors of postoperative UTI. PMUC was not associated (p = 0.65) with postoperative UTI in the multivariate analysis.

Conclusions: Intraoperative SC and RPUC showed a stronger association with postoperative UTI compared with PMUC and may be considered for routine use. Female gender and ASA-3 score were identified as independent risk factors. In patients who develop UTI, prior empirical or prophylactic antibiotic use may limit pathogen detection in postoperative urine cultures; therefore, intraoperative cultures play a critical role in early and targeted treatment.

Purpose: The proposed review aims to provide a guide on current developments of artificial intelligence in Endourological practice, with an insight and descriptive guide on the potential integration of advanced technologies into Endourology. The purpose of this review article is also to gather the recent advances in artificial intelligence applications in urology, and to highlight the potential applications of novel trends and technologies being developed in artificial intelligence.

Methods: Artificial intelligence is conquering the scientific landscape, and the medical field is not an exception. The work starts with a concise review of the state of the art and recent development of artificial intelligence and machine learning in urology and endourology. Moreover, an advanced description of novel technologies is presented in a clear manner, easy to follow by clinicians. The novel technologies include the causal artificial intelligence modeling, based on scientific constraints and directed acyclic graphs, as well as solving inverse problems and optimal decision making through reinforcement learning.

Results: The proposed manuscripts showcase potential applications of novel technologies in artificial intelligence, leading to democratizing its adoption. Theses novel technologies ease the explanation of the predictions performed by artificial intelligence algorithms, and follow causality and time sequencing constraints. Moreover, they can be useful to integrate expert's partial knowledge of complex medical phenomenon into their architecture by construction.

Conclusions: The guide also showcases the potential applications and limitation in the field of urology. The proposed work ends in the current challenges hindering the democratization of artificial intelligence in Endourology.

Purpose: Despite well-defined standards for urethral stricture management, significant practice variations persist. This survey assessed guideline adherence among Turkish urologists.

Methods: An online SurveyMonkey survey was sent to Turkish Urological Association members, open October 10-17, 2021, with two reminders. Data were centrally collected and analyzed using descriptive statistics.

Results: Of 2,078 members, 222 (11%) responded, mostly aged 30-45 years. Retrograde urethrography (26%), uroflowmetry (90%), and cystourethroscopy (61%) were used for diagnosis, with academic urologists employing these more often (p < 0.05). Blind dilatation with metal bougies (47%) exceeded plastic dilators over guidewire (23%) or disposable catheters (26%). Material preference was unrelated to experience (p = 0.39), but non-metal methods were more common in academic centers (p = 0.04). For 1-2 cm primary bulbar strictures, 7% chose urethroplasty, while 72% preferred Direct Vision Internal Urethrotomy (DVIU) with dilatation. Academic urologists performed more urethroplasties (p = 0.01). In recurrent cases, 76.5% performed DVIU ≥ 4 times, and 79.3% recommended periodic post-DVIU dilatation.

Conclusions: Urologists' approaches to urethral strictures often deviate from guidelines. Retrograde urethrography use is low, metal bougies dominate dilatation, and urethroplasty is underused, favoring repeated DVIU and dilatation. Academic urologists adhere more to guideline recommendations than non-academic peers.

Purpose: Procalcitonin (PCT) is an acute-phase protein and widely used marker for diagnosing bacterial infection and sepsis, but its physiological role remains incompletely defined. Interleukin-1β (IL-1β) is a critical mediator of the immune response to infection, whose excessive release can drive remote organ injury and dysfunction. Its secretion is therefore tightly controlled. Because other acute-phase proteins have been shown to regulate IL-1β secretion, we investigated whether PCT exerts a similar immunomodulatory effect and whether this influences sepsis severity, particularly in Gram-negative urosepsis.

Methods: Primary human mononuclear leukocytes were stimulated to induce IL-1β release in the presence or absence of increasing PCT concentrations. In parallel, peak PCT levels, infection source, and causative pathogen were analyzed retrospectively in uroseptic patients in comparison to other septic sources, and related to Sepsis-related Organ Failure Assessment (SOFA) scores and serum lactate concentrations.

Results: PCT significantly inhibited IL-1β secretion from primary mononuclear leukocytes across the 2.5-75 µg/L concentration range. Clinically, the highest PCT peaks occurred in patients with Gram-negative urosepsis. Among these, those with peak PCT values within 2.5-75 µg/L had significantly lower SOFA scores and lactate levels-established indicators of sepsis severity and prognosis-compared with patients outside this range.

Conclusion: Within a defined concentration range, PCT down-regulates IL-1β secretion and is associated with reduced markers of disease severity in Gram-negative urosepsis, compared to other sepsis entities. These findings suggest that pronounced PCT elevations in this setting may represent a protective host response rather than a worse prognosis, pointing to a novel immunomodulatory role of PCT in urosepsis that warrants further investigation. DRKS00037950, retrospectively registered on 22 September 2025.

Purpose: Fluoroscopy is commonly used during Percutaneous Nephrolithotomy (PCNL) for renal access and tract dilatation; however, it is associated with radiation exposure for both patients and surgical staff. Strategies to minimize exposure include reducing fluoroscopy time, which serves as a surrogate marker of radiation dose. This study aims to examine the effect of reducing fluoroscopy time using intermittent fluoroscopy on treatment and perioperative outcomes in supine PCNL.

Methods: We retrospectively analyzed data from 446 patients who underwent supine PCNL between April 2021 and August 2025. After applying exclusion criteria, 392 patients were included. Two experienced surgeons performed or supervised the procedures, one utilizing intermittent fluoroscopy and the other live fluoroscopy. Baseline demographics, stone characteristics, operative variables, fluoroscopy time, stone-free rates (SFR), complications, and hospital stay were compared. Propensity score matching (PSM) was conducted to minimize group baseline differences.

Results: Before matching, 310 patients underwent intermittent fluoroscopy, and 82 underwent live fluoroscopy. After PSM, 82 patients remained in each group with comparable demographics and stone characteristics. Median fluoroscopy time was significantly lower in the intermittent group (25.5 s [IQR: 18-35.25]) compared with the live group (267 s [IQR: 182.5-314]; p < 0.001). Stone-free rates were similar (79.3% vs. 81.7%; p = 0.694), as were operative time, hospital stay, and complication rates(all p > 0.05).

Conclusion: Intermittent fluoroscopy during supine PCNL substantially reduces fluoroscopy time without compromising stone-free rates, operative outcomes, or complication rates. This approach may be considered a safer alternative for minimizing radiation exposure to patients and healthcare providers.