Background: Accurately predicting the outcome of extracorporeal shock wave lithotripsy (ESWL) is a persistent clinical challenge. While machine learning (ML) offers potential for improved predictions, the opacity of many models hinders clinical trust and adoption. This study aimed to develop and validate an interpretable ML model to predict ESWL success using routinely available clinical data.
Patients and methods: In this retrospective cohort study, we analyzed data from 1,501 patients treated with a single ESWL session at a single institution (2022-2024). Six ML algorithms were trained on 75% of the data (n=1,125), with performance evaluated on a hold-out test set (n=376). Techniques to manage significant class imbalance were employed. Model interpretability was achieved using SHapley Additive exPlanations (SHAP).
Results: The extreme gradient boosting (XGBoost) model demonstrated the best discriminative performance, with an area under the receiver operating characteristic curve (ROC-AUC) of 0.723 (95% CI: 0.662-0.784). However, a critical trade-off was observed: the model exhibited high specificity (95.2%) but low sensitivity (35.4%), meaning it identified most successes but missed nearly two-thirds of treatment failures. Stone density and size were the most influential predictors, and SHAP analysis provided clinically plausible, individualized explanations for predictions.
Conclusions: We present a transparent, interpretable ML framework for ESWL outcome prediction. While the model aligns with clinical reasoning and offers a foundation for trustworthy artificial intelligence, its current low sensitivity limits immediate standalone clinical utility for ruling out ESWL failure. The framework highlights the imperative for future work to improve sensitivity through richer datasets and prospective validation before integration into clinical pathways.
Purpose: BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) remains a persistent challenge. This study examines Romanian urologists' clinical practices, focusing on treatment preferences and awareness of emerging therapies for BCG-unresponsive disease.
Methods: A cross-sectional, web-based survey comprising 24 items was distributed to selected urologists who manage NMIBC via professional mailing lists. Data were collected between May 15 and June 30, 2025.
Results: Out of 400 invited urologists, 216 completed the survey. Radical cystectomy (RC) was the most preferred treatment for BCG-unresponsive NMIBC, recommended by 67% of respondents, followed by tumor resection with surveillance (15%), repeat BCG instillation (14%), and intravesical chemotherapy (4%). Neither clinical trials nor intravenous checkpoint inhibitors were used. Among those using intravesical chemotherapy, gemcitabine was the most commonly used agent (85%), followed by mitomycin C (5%), gemcitabine/docetaxel (4%), gemcitabine/ mitomycin C (3%), docetaxel (2%), and valrubicin (1%). Oncological safety concerns were the main barrier to adopting bladder-sparing therapies. Awareness of FDA-approved therapies for BCG-unresponsive disease, Nadofaragene firadenovec, Nogapendekin alfa inbakicept-pmln, and Pembrolizumab, was limited; 61% of urologists were unaware of all three, and only 1% had used any. BCG shortages were reported by 93% of respondents at some point, who adapted by reducing doses and prioritizing high-grade T1 and CIS cases. Most recognized intravesical chemotherapy as an alternative and were willing to use it if needed.
Conclusions: Though RC remains the predominant approach for BCG-unresponsive cases, over half of urologists' report using intravesical chemotherapy, reflecting interest in bladder-sparing strategies rather than newly approved FDA agents.
Introduction: It is estimated that more than 150 million men worldwide have erectile dysfunction (ED) and this number will reach more than 300 million by 2025. There is strong evidence that ED increases the risk of future cardiovascular events. ED and CAD share common risk factors. High sensitivity C-Reactive Protein (hs-CRP) is an important inflammatory biomarker in subclinical atherosclerosis. Albuminuria is also a marker of widespread endothelial dysfunction and is thought to be associated with ED. This study was conducted to analyze the prevalence of ED and the relationship between hs-CRP, albuminuria, and cardiovascular risk factors with the occurrence of ED in CAD patients.
Materials and methods: From July 2024 to October 2024, 288 CAD cases from Saiful Anwar general hospital heart clinic met the inclusion criteria. Data on hs-CRP, albuminuria, and cardiovascular risk factors such as age, hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking were observed in relation to incidence of erectile dysfunction in CAD patients. Then logistic regression analysis was performed.
Results: There were 255 CAD patients (88.5%) who experienced ED. There was no significant relationship between hs-CRP and albuminuria with ED in CAD patients (p>0.05). Significant risk factors for ED in CAD patients were age (OR = 15.92; 95% CI = 4.67-54.22; p=0.000), triglycerides (OR = 2.52; 95% CI = 1.12-5.66; p=0.024), and smoking (OR = 0.29; 95% CI = 0.09-0.89; p=0.031).
Conclusions: The prevalence of erectile dysfunction was 88.5% in patients with coronary artery disease. Hs-CRP and albuminuria did not have a significant relationship with the incidence of ED in patients with CAD. Risk factors that independently affect incidence of ED in patients with CAD are age, smoking, and hypertriglyceridemia.
Introduction: after androgen ablation treatment for prostate cancer, virtually all patients with recurrent or advanced disease develop castration resistance (CRPC). Abiraterone and enzalutamide are the most commonly used novel antiandrogen treatments in patients with castration-resistant prostate cancer (CRPC). The solute carrier transporter (SLCO2B1) enables various anticancer compounds or hormones to enter cells, including the adrenal androgen dehydroepiandrosterone (DHEAS), a precursor to the most potent androgen dihydroxytestosterone (DHT), which is the substrate binding and activating the androgen receptor in normal and prostate cancer (PCa) cells. Other substrates of SLCO2B1 are statins. An in vitro-part study showed that statins, by binding to SLCO2B1, can block the uptake of DHEAS competitively, decreasing the available intratumoral androgen and improving and extending the effect of primary ADT.
Aim: to evaluate whether the addition of statins to the new antiandrogens (abiraterone or enzalutamide) affects overall and progression-free survival in patients with metastatic castration-resistant prostate cancer.
Materials and methods: medical records of patients with mCRPC taking abiraterone or enzalutamide between December 2019 and January 2022 were reviewed in a tertiary hospital. Patients were assessed for statin use at the time of treatment initiation, progression free (PFS) and overall survival (OS), prostate-specific antigen (PSA) variations, and other variables of interest. Statistical analysis was performed using SPSS 22.0.
Results: a total of 107 patients receiving ADT (63 abiraterone - 59.4% - and 43 enzalutamide - 40.6%) for mCRPC in this time period were eligible for inclusion in this retrospective study. Patients had a mean age of 76.5 years (48-93). 26 patients had surgery with curative intent prior to the treatment (24.5%), 19 had previous pelvic radiotherapy with curative intent (17.9%) and 20 patients (18.9%) were previously treated with chemotherapy with docetaxel. Statins use was a significant prognostic factor for longer PFS, with a mean time of 13,68 months for those who do not use statins and 19,62 months for those who do (p<0.06). No statistically significant difference was found in OS or global mortality between the patients who use or do not use statins. Statins use also did not show any difference in the reduction of PSA values during the treatment with ADT.
Conclusions: Our study suggests a prognostic impact of statin use in the PFS in patients receiving abiraterone or enzalutamide for mCRPC. This may be related to the enhancement of the antitumor activity of the ADT drugs, but also to the cardioprotective effects associated with statin use.
Introduction: Hyperthermic intravesical chemotherapy (HIVeC) with mitomycin C (MMC) is an emerging strategy in the management of intermediate-risk non-muscle-invasive bladder cancer (Ir-NMIBC). By combining chemotherapy with controlled hyperthermia (43°C), this approach aims to enhance drug absorption, increase cytotoxicity, and stimulate immune activation, potentially improving efficacy compared to standard MMC. The aim of this study was to compare oncologic efficacy, adverse effects, and safety between HIVeC and standard normothermic MMC in patients with Ir-NMIBC.
Patients and methods: we conducted a retrospective cohort study including 76 patients with Ir-NMIBC treated between January 2020 and december 2023. Patients received HIVeC (n=36) or standard MMC (n=40) following complete transurethral resection of bladder tumor (TUrBT). The instillation schedule consisted of four weekly induction instillations followed by three monthly maintenance instillations. The primary endpoint was recurrence-free survival (rFs); secondary endpoints included progression-free survival (PFs), adverse events (Aes), and treatment compliance.
Results: A total of 76 patients were included: 36 received HIVeC and 40 received standard MMC. Baseline characteristics were balanced across groups, with a median age of 68 years and 86.8% male. Most tumors were unifocal (85.5%), stage pTa (88.2%), and low-grade (61.8%). At a median follow-up of 36 months (IQr 24-36), recurrence occurred in 38.9% of HIVeC patients vs 30.0% in the MMC group. Median time to recurrence was longer with HIVeC (15.0 vs 10.5 months). The 24-months recurrence-free survival was 62.2% for HIVeC and 69.4% for MMC (p=0.365). Progression to muscle-invasive disease occurred in one MMC patient (2.5%); none progressed in the HIVeC arm (PFs at 24 months: 100% vs 97.5%, p=0.343). Compliance was high in both arms (HIVeC 88.9%, MMC 87.5%). Adverse events were mild (grade 1-2) and evenly distributed; no grade ≥3 events were observed. Treatment discontinuation due to toxicity occurred in 13% of HIVeC and 7% of MMC patients (p=0.47).
Conclusions: HIVeC with MMC demonstrated comparable oncologic outcomes to normothermic MMC in Ir-NMIBC, with a longer time to recurrence and similar tolerability. These findings suggest its potential use in selected patients, but should be interpreted with caution due to the retrospective design and limited sample size.
Background: Extracorporeal shock wave lithotripsy (ESWL) is a widely utilized, noninvasive treatment for renal and ureteric stones. Accurate prediction of treatment outcomes is essential for improving patient counseling and optimizing clinical management. Established scoring systems, such as the 'Triple-D' score - which incorporates stone Density, Diameter, and skin-to-stone Distance -and the 'Quadruple-D' score - which adds factors like stone location or hydronephrosis status - are used to stratify patients by risk. However, these tools have limitations in predictive accuracy. This study aimed to evaluate and compare the predictive performances of the Triple-D and Quadruple-D scores against a novel regression-based model for ESWL outcomes.
Methods: A retrospective study was conducted on 1,000 adult patients treated with ESWL using the Dornier Compact Delta® III Pro lithotripter from May 2022 to November 2023. Key predictors of ESWL failure were identified using multivariable logistic regression with internal validation. Predictive performances were compared using receiver operating characteristic (ROC) analysis, with statistical differences assessed by DeLong's test. Model calibration and clinical utility were examined through calibration plots and decision curve analysis (DCA).
Results: ESWL treatment success was achieved in 87.5% of patients. Independent predictors of failure included prior urologic intervention (adjusted odds ratio [aOR] 2.64, 95% CI 1.75-3.99), multiple stones (aOR 0.45, 95% CI 0.24-0.77), higher stone density (per 100 Hounsfield Units increase; p<0.001), and increased skin-to-stone distance (per cm; aOR 1.18, 95% CI 1.06-1.30). The regression-based model showed superior discrimination (AUC 0.92) compared to the Quadruple-D (AUC 0.81, p=0.01) and Triple-D (AUC 0.72, p<0.001) scores. Calibration and DCA confirmed the model's improved accuracy and clinical benefit.
Conclusions: The regression-based model outperforms existing Triple-D and Quadruple-D scores in predicting ESWL failure, providing enhanced individualized risk stratification. This may facilitate better patient selection and treatment planning. Prospective validation is warranted.
Background: Androgen deprivation therapy (ADT) is a cornerstone treatment for advanced prostate cancer. While effective, traditional injectable luteinizing hormone-releasing hormone (LHRH) agonists are associated with an initial testosterone flare and potential cardiovascular risks. Relugolix is a novel, oral gonadotropin-releasing hormone (GnRH) antagonist developed to provide rapid suppression without a testosterone flare. This review synthesizes the latest evidence on the efficacy, safety, and clinical utility of relugolix.
Methods: This non-systematic review was conducted via a search of PubMed and MEDLINE databases up to July 2025 using the terms "relugolix" AND "ADT" OR "Androgen Deprivation Therapy" AND "Prostate Cancer." Only original studies in English were included.
Results: The phase III HERO trial established the superiority of relugolix over leuprolide, demonstrating higher rates of sustained castration (96.7% vs 88.8%) and a significantly faster onset of action. Relugolix also showed a 54% reduction in major cardiovascular adverse events. Furthermore, it exhibited equivalent efficacy to injectable degarelix when combined with radiotherapy, but with more robust testosterone recovery after treatment cessation (52% vs 16%). Real-world data indicates high patient adherence to the oral regimen, and a cost-effectiveness analysis suggests it is a cost-effective option despite a higher drug cost.
Conclusions: Relugolix represents a significant advancement in ADT, offering a potent, oral alternative with a rapid onset of action, a superior cardiovascular safety profile, and improved testosterone recovery. It provides clinicians with a valuable option for treating advanced prostate cancer, particularly in patients with cardiovascular comorbidities.
Introduction: VED is a handheld pump that creates negative pressure around the penis to draw blood into the corpora cavernosa. Although included in guidelines as a noninvasive option, its uptake is limited by fragmented evidence. Current Grade C recommendations are largely based on post-prostatectomy studies, and no systematic review/meta-analysis has evaluated VED across other ED etiologies (diabetic, cardiovascular, idiopathic) or compared it head-to-head with pharmacotherapy using the IIEF.
Methods: We searched PubMed, ScienceDirect, and Cochrane Library using relevant keywords to identify studies assessing VED's effects on erectile dysfunction patients. The primary outcome we assessed in this systematic review was erectile function based on the International Index of Erectile Function (IIEF). Study quality was assessed using the Revised Cochrane Risk of Bias tool (RoB2) for Randomized Controlled Trial (RCT) studies and using ROBINS-I for non-RCT studies. Meta-analyses were conducted using Review Manager 5.4.
Results: The meta-analysis results of this study showed that when VED was used as a single therapeutic modality compared with Phosphodiesterase-5 (PDE5) inhibitors (PDE5Is), there was no significant difference (p=0.77). However, when compared with the placebo group (no intervention), VED provided significantly better outcomes [MD: 4.44 (95% CI: 3.04-5.84) p<0.001). Similarly, when VED was combined with PDE5i, its effectiveness was significantly better than PDE5i therapy alone [MD: 4.19 (95% CI: 0.81-7.57; p<0.001)]. In terms of safety, VED is also relatively safe and has mild and reversible side effects.
Conclusions: VED is effective as a therapy either alone or as an adjunct to PDE5i therapy in patients with erectile dysfunction.
Background: Prediabetes, defined as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), is recognized as an increasing metabolic disorder globally. Although its vascular and metabolic implications are well established, the link between prediabetes and male sexual dysfunction is uncertain. This meta-analysis was performed to summarize available evidence on the relationship between prediabetes and sexual dysfunction in men.
Methods: A systematic literature search of PubMed, Embase, and Scopus from inception to July 2025 was undertaken to retrieve observational studies reporting sexual dysfunction outcomes (erectile dysfunction or premature ejaculation) in prediabetic men. The eligibility criteria were adult men with prediabetes and comparative data with normoglycemic controls. Studies were screened by two independent reviewers who also extracted data and evaluated study quality using the Newcastle-Ottawa Scale (NOS). Meta-analysis with random effects model was employed to combine effect sizes and assess heterogeneity on the basis of I² statistic. Funnel plots and Egger's test were employed to investigate publication bias. GRADE approach was applied to grade the certainty of the evidence according to risk of bias, inconsistency, indirectness, imprecision, and publication bias.
Results: A total of ten studies with 11,000 participants were available for analysis. Combined odds ratio (OR) of sexual dysfunction in prediabetic men compared to normoglycemic men was 2.50 (95% CI: 1.35-4.64), indicating significant association with high heterogeneity (I² = 87.9%, p<0.001). Funnel plot asymmetry was checked by visual inspection and confirmed by Egger's regression test for publication bias, which was not significant (p=0.275). According to GRADE, the quality of evidence was generally low, downgraded for high heterogeneity and imprecision but upgraded for large effect size.
Conclusions: We found that men with prediabetes have approximately 2.5-fold higher odds of sexual dysfunction than men with normoglycemia. Due to the high pooled effect size, although with low certainty of evidence, additional high-quality prospective studies are needed to replicate findings and explore the underlying mechanisms.
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