Pub Date : 2025-11-21DOI: 10.1097/ju.0000000000004859
Nicole Zeltser,Roni Haas,Christine Ibilibor,Jonathan Gelfond,Martin Goros,Teresa L Johnson-Pais,Ian M Thompson,Tyler M Seibert,Robin J Leach,Paul C Boutros,Michael A Liss
BACKGROUND AND OBJECTIVEOverdiagnosis of prostate cancer (PC) through prostate-specific antigen (PSA) testing at short intervals remains common. While baseline serum PSA abundance < 1 ng/mL warrants infrequent screening, it is critical to foster advanced diagnostic practices for men with baseline serum PSA ≥ 1 ng/mL, who are at higher risk for clinically significant disease. We investigated whether common germline variants could enhance screening recommendations in men with PSA ≥1 ng/mL.METHODSPolygenic hazard scores for the risk of PC diagnosis (PHS290) were computed in a diverse, matched, prospective cohort of 310 men with baseline PSA ≥ 1 ng/mL with or without PC. Regression models were used to predict PC clinical risk groups with PHS290, while incorporating clinical covariates and an existing 5-year-risk calculator score.KEY FINDINGSPHS290 stratified individuals with PSA ≥1 ng/mL into risk groups and identified men with intermediate- & high-risk PC. Adding PHS290 to our model for predicting time to intermediate- & high-risk PC improved predictions over an existing pre-biopsy 5-year risk calculator.CONCLUSIONSand Clinical Implications: Our study demonstrates the potential of genetic scores to advance screening guidance. The PC risk stratification capabilities of molecular biomarkers in tiered screening strategies merit further study in large cohorts.
{"title":"Joint Biochemical & Genetic Prostate Cancer Risk Stratification.","authors":"Nicole Zeltser,Roni Haas,Christine Ibilibor,Jonathan Gelfond,Martin Goros,Teresa L Johnson-Pais,Ian M Thompson,Tyler M Seibert,Robin J Leach,Paul C Boutros,Michael A Liss","doi":"10.1097/ju.0000000000004859","DOIUrl":"https://doi.org/10.1097/ju.0000000000004859","url":null,"abstract":"BACKGROUND AND OBJECTIVEOverdiagnosis of prostate cancer (PC) through prostate-specific antigen (PSA) testing at short intervals remains common. While baseline serum PSA abundance < 1 ng/mL warrants infrequent screening, it is critical to foster advanced diagnostic practices for men with baseline serum PSA ≥ 1 ng/mL, who are at higher risk for clinically significant disease. We investigated whether common germline variants could enhance screening recommendations in men with PSA ≥1 ng/mL.METHODSPolygenic hazard scores for the risk of PC diagnosis (PHS290) were computed in a diverse, matched, prospective cohort of 310 men with baseline PSA ≥ 1 ng/mL with or without PC. Regression models were used to predict PC clinical risk groups with PHS290, while incorporating clinical covariates and an existing 5-year-risk calculator score.KEY FINDINGSPHS290 stratified individuals with PSA ≥1 ng/mL into risk groups and identified men with intermediate- & high-risk PC. Adding PHS290 to our model for predicting time to intermediate- & high-risk PC improved predictions over an existing pre-biopsy 5-year risk calculator.CONCLUSIONSand Clinical Implications: Our study demonstrates the potential of genetic scores to advance screening guidance. The PC risk stratification capabilities of molecular biomarkers in tiered screening strategies merit further study in large cohorts.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"19 1","pages":"101097JU0000000000004859"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSETo evaluate whether relative renal volume measured by ultrasound predicts differential renal function measured by dimercaptosuccinic acid scintigraphy in children with vesicoureteral reflux.MATERIALS AND METHODSWe retrospectively reviewed pediatric patients with vesicoureteral reflux followed at a single tertiary center between January 2008 and May 2023. Collected variables included gender, reflux grade, laterality, comorbidities, renal volume by ultrasound, relative renal volume, and differential renal function by scintigraphy. Patients with bilateral reflux or urological comorbidities were excluded. Agreement between relative renal volume and differential renal function was analyzed.RESULTSAmong 921 patients reviewed, 147 had unilateral primary reflux without comorbidities (83 females, 64 males): 81 had grades I to III, and 66 had grades IV or V. Median differential function was 33% (interquartile range: 22% to 44%) and median relative renal volume was 36% (interquartile range: 25% to 44%). The agreement was strong (intraclass correlation coefficient 0.94; 95% confidence interval 0.92 to 0.96; p < 0.001). Relative renal volume overestimated function by 2% (95% confidence interval: -13% to 10%). A cut-off of 40% predicted a differential function below 40% with 89% sensitivity and 89% specificity (area under the curve 0.94; 95% confidence interval 0.90 to 0.97).CONCLUSIONSIn children with unilateral primary vesicoureteral reflux, relative renal volume by ultrasound accurately predicts differential renal function. This non-invasive alternative may reduce the need for scintigraphy, limiting radiation exposure and healthcare costs.
{"title":"PREDICTING DIFFERENTIAL RENAL FUNCTION IN CHILDREN WITH VESICOURETERAL REFLUX USING ULTRASOUND.","authors":"Oriol Martín-Solé,Leopoldo Tapia Moral,Sonia Pérez-Bertólez,Blanca Capdevila Vilaró,Ainhoa Lombardero Hidalgo,Anna Domènech Plana,Paula Salcedo Arroyo,Jesús González Cayón,Xavier Tarrado,Luis García-Aparicio","doi":"10.1097/ju.0000000000004858","DOIUrl":"https://doi.org/10.1097/ju.0000000000004858","url":null,"abstract":"PURPOSETo evaluate whether relative renal volume measured by ultrasound predicts differential renal function measured by dimercaptosuccinic acid scintigraphy in children with vesicoureteral reflux.MATERIALS AND METHODSWe retrospectively reviewed pediatric patients with vesicoureteral reflux followed at a single tertiary center between January 2008 and May 2023. Collected variables included gender, reflux grade, laterality, comorbidities, renal volume by ultrasound, relative renal volume, and differential renal function by scintigraphy. Patients with bilateral reflux or urological comorbidities were excluded. Agreement between relative renal volume and differential renal function was analyzed.RESULTSAmong 921 patients reviewed, 147 had unilateral primary reflux without comorbidities (83 females, 64 males): 81 had grades I to III, and 66 had grades IV or V. Median differential function was 33% (interquartile range: 22% to 44%) and median relative renal volume was 36% (interquartile range: 25% to 44%). The agreement was strong (intraclass correlation coefficient 0.94; 95% confidence interval 0.92 to 0.96; p < 0.001). Relative renal volume overestimated function by 2% (95% confidence interval: -13% to 10%). A cut-off of 40% predicted a differential function below 40% with 89% sensitivity and 89% specificity (area under the curve 0.94; 95% confidence interval 0.90 to 0.97).CONCLUSIONSIn children with unilateral primary vesicoureteral reflux, relative renal volume by ultrasound accurately predicts differential renal function. This non-invasive alternative may reduce the need for scintigraphy, limiting radiation exposure and healthcare costs.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"169 1","pages":"101097JU0000000000004858"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1097/ju.0000000000004844
Margaret S Pearle,Brian R Matlaga,Jodi A Antonelli,Thomas Chi,Ryan S Hsi,Sennett K Kim,Erin Kirkby,Bodo Knudsen,Kevin Koo,Naim M Maalouf,Vernon M Pais,Ann Paris,Kristina L Penniston,Kymora B Scotland,Lesley H Souter,Nicole Streeper,Gregory Tasian,Kyle D Wood,Justin B Ziemba
PURPOSEThis Guideline covers the surgical treatment of patients with ureteral and/or kidney stones and is intended for clinicians evaluating and managing patients with these diseases. The summary presented herein represents Part III of the three-part series dedicated to Surgical Management of Kidney and Ureteral Stones and Future Directions.MATERIALS AND METHODSThis systematic review was conducted in two planned stages, including a search for systematic reviews followed by a search for primary literature.OVID was used to systematically search MEDLINE and EMBASE databases for articles evaluating surgical management of kidney and ureteral stones. The Panel selected control articles that were deemed relevant and the articles were compared with the literature search strategy output. The methodologist then updated the strategy as necessary to capture all control articles. Databases were searched for studies published from January 2000 through May 2025 (week 20). In addition to the MEDLINE and EMBASE databases searches, reference lists of included systematic reviews and primary literature were scanned for potentially useful studies.RESULTSThe Panel addressed adult and pediatric patients with ureteral and/or kidney stones for whom surgical intervention may be indicated. Each statement herein addressed a particular patient scenario for which the choice of surgical intervention was reviewed and justified. In addition, the Panel reviewed and analyzed the utility of specific surgical techniques, technologies, or medications aimed at improving patient outcomes.CONCLUSIONSSelection of optimal treatment modalities for patients with kidney and/or ureteral stones is determined by patient factors, urinary tract anatomy, and stone characteristics and are guided by shared decision-making that additionally takes into account patient goals and preferences, resource availability, and physician expertise. This Guideline serves as a resource for clinicians and patients to provide the best available evidence on which to base discussions with patients in a shared decision-making process to arrive at appropriate treatment decisions.
{"title":"Surgical Management of Kidney and Ureteral Stones: AUA Guideline (2026) Part III: Evaluation and Treatment of Patients with Kidney and/or Ureteral Stones.","authors":"Margaret S Pearle,Brian R Matlaga,Jodi A Antonelli,Thomas Chi,Ryan S Hsi,Sennett K Kim,Erin Kirkby,Bodo Knudsen,Kevin Koo,Naim M Maalouf,Vernon M Pais,Ann Paris,Kristina L Penniston,Kymora B Scotland,Lesley H Souter,Nicole Streeper,Gregory Tasian,Kyle D Wood,Justin B Ziemba","doi":"10.1097/ju.0000000000004844","DOIUrl":"https://doi.org/10.1097/ju.0000000000004844","url":null,"abstract":"PURPOSEThis Guideline covers the surgical treatment of patients with ureteral and/or kidney stones and is intended for clinicians evaluating and managing patients with these diseases. The summary presented herein represents Part III of the three-part series dedicated to Surgical Management of Kidney and Ureteral Stones and Future Directions.MATERIALS AND METHODSThis systematic review was conducted in two planned stages, including a search for systematic reviews followed by a search for primary literature.OVID was used to systematically search MEDLINE and EMBASE databases for articles evaluating surgical management of kidney and ureteral stones. The Panel selected control articles that were deemed relevant and the articles were compared with the literature search strategy output. The methodologist then updated the strategy as necessary to capture all control articles. Databases were searched for studies published from January 2000 through May 2025 (week 20). In addition to the MEDLINE and EMBASE databases searches, reference lists of included systematic reviews and primary literature were scanned for potentially useful studies.RESULTSThe Panel addressed adult and pediatric patients with ureteral and/or kidney stones for whom surgical intervention may be indicated. Each statement herein addressed a particular patient scenario for which the choice of surgical intervention was reviewed and justified. In addition, the Panel reviewed and analyzed the utility of specific surgical techniques, technologies, or medications aimed at improving patient outcomes.CONCLUSIONSSelection of optimal treatment modalities for patients with kidney and/or ureteral stones is determined by patient factors, urinary tract anatomy, and stone characteristics and are guided by shared decision-making that additionally takes into account patient goals and preferences, resource availability, and physician expertise. This Guideline serves as a resource for clinicians and patients to provide the best available evidence on which to base discussions with patients in a shared decision-making process to arrive at appropriate treatment decisions.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"104 1","pages":"101097JU0000000000004844"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1097/ju.0000000000004842
Margaret S Pearle,Brian R Matlaga,Jodi A Antonelli,Thomas Chi,Ryan S Hsi,Sennett K Kim,Erin Kirkby,Bodo Knudsen,Kevin Koo,Naim M Maalouf,Vernon M Pais,Ann Paris,Kristina L Penniston,Kymora B Scotland,Lesley H Souter,Nicole Streeper,Gregory Tasian,Kyle D Wood,Justin B Ziemba
PURPOSEThis Guideline covers the evaluation and treatment of patients with ureteral and/or kidney stones. The summary presented herein represents Part I of the three-part series dedicated to Surgical Management of Kidney and Ureteral Stones. Please refer to Part II for additional information on this topic.MATERIALS AND METHODSThis systematic review was conducted in two planned stages, including a search for systematic reviews followed by a search for primary literature.OVID was used to systematically search MEDLINE and EMBASE databases for articles evaluating surgical management of kidney and ureteral stones. The Panel selected control articles that were deemed relevant and the articles were compared with the literature search strategy output. The methodologist then updated the strategy as necessary to capture all control articles. Databases were searched for studies published from January 2000 through May 2025 (week 20). In addition to the MEDLINE and EMBASE databases searches, reference lists of included systematic reviews and primary literature were scanned for potentially useful studies.RESULTSThe Panel addressed adult and pediatric patients with ureteral and/or kidney stones for whom surgical intervention may be indicated. Each statement herein addressed a particular patient scenario for which the choice of surgical intervention was reviewed and justified. In addition, the Panel reviewed and analyzed the utility of specific surgical techniques, technologies, or medications aimed at improving patient outcomes.CONCLUSIONSSelection of optimal treatment modalities for patients with kidney and/or ureteral stones is determined by patient factors, urinary tract anatomy, and stone characteristics and are guided by shared decision-making that additionally takes into account patient goals and preferences, resource availability, and physician expertise. This Guideline serves as a resource for clinicians and patients to provide the best available evidence on which to base discussions with patients in a shared decision-making process to arrive at appropriate treatment decisions.
{"title":"Surgical Management of Kidney and Ureteral Stones: AUA Guideline (2026) Part I: Evaluation and Treatment of Patients with Kidney and/or Ureteral Stones.","authors":"Margaret S Pearle,Brian R Matlaga,Jodi A Antonelli,Thomas Chi,Ryan S Hsi,Sennett K Kim,Erin Kirkby,Bodo Knudsen,Kevin Koo,Naim M Maalouf,Vernon M Pais,Ann Paris,Kristina L Penniston,Kymora B Scotland,Lesley H Souter,Nicole Streeper,Gregory Tasian,Kyle D Wood,Justin B Ziemba","doi":"10.1097/ju.0000000000004842","DOIUrl":"https://doi.org/10.1097/ju.0000000000004842","url":null,"abstract":"PURPOSEThis Guideline covers the evaluation and treatment of patients with ureteral and/or kidney stones. The summary presented herein represents Part I of the three-part series dedicated to Surgical Management of Kidney and Ureteral Stones. Please refer to Part II for additional information on this topic.MATERIALS AND METHODSThis systematic review was conducted in two planned stages, including a search for systematic reviews followed by a search for primary literature.OVID was used to systematically search MEDLINE and EMBASE databases for articles evaluating surgical management of kidney and ureteral stones. The Panel selected control articles that were deemed relevant and the articles were compared with the literature search strategy output. The methodologist then updated the strategy as necessary to capture all control articles. Databases were searched for studies published from January 2000 through May 2025 (week 20). In addition to the MEDLINE and EMBASE databases searches, reference lists of included systematic reviews and primary literature were scanned for potentially useful studies.RESULTSThe Panel addressed adult and pediatric patients with ureteral and/or kidney stones for whom surgical intervention may be indicated. Each statement herein addressed a particular patient scenario for which the choice of surgical intervention was reviewed and justified. In addition, the Panel reviewed and analyzed the utility of specific surgical techniques, technologies, or medications aimed at improving patient outcomes.CONCLUSIONSSelection of optimal treatment modalities for patients with kidney and/or ureteral stones is determined by patient factors, urinary tract anatomy, and stone characteristics and are guided by shared decision-making that additionally takes into account patient goals and preferences, resource availability, and physician expertise. This Guideline serves as a resource for clinicians and patients to provide the best available evidence on which to base discussions with patients in a shared decision-making process to arrive at appropriate treatment decisions.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"32 1","pages":"101097JU0000000000004842"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1097/ju.0000000000004853
Samuel J Ivan,Elia Abou Chawareb,Muhammed Hammad,Michael Lesgart,Bryce Baird,Petar Bajic,David W Barham,Helen L Bernie,Raevti Bole,Paul Chung,Ketch Cowan,Zayda Dominick,Jacob Good,Sevann Helo,Michael H Hsieh,Brian H Im,Yash Kadakia,Tobias Kohler,Aaron C Lentz,Marcelo Mass-Lindenbaum,Allen F Morey,Vi Nguyen,Thairo Pereira,Paul Perito,Hossein Sadeghi-Nejad,Joshua Schammel,Anand Shridharani,Nicklas Sarantos,Alfredo Suarez-Sarmiento,J Nicholas Warner,Charles Welliver,Matthew Ziegelmann,Faysal A Yafi,Martin S Gross,Jay Simhan
PURPOSEAvailable data is conflicting and limited regarding the antimicrobial effectiveness of 0.05% Chlorhexidine Gluconate (0.05% CHG) with hydrophilic inflatable penile prostheses (IPP). We utilized a large multi-institutional cohort to explore the relationship between intraoperative 0.05% CHG use and hydrophilic IPP infection.MATERIALS AND METHODSWe conducted a retrospective, multi-institutional review of patients who underwent hydrophilic IPP implantation. Consecutive cases involving intraoperative 0.05% CHG as an irrigant and/or dip were compared to a similar number of consecutive control cases without 0.05% CHG. The primary outcome was IPP explant for infection. Predictors of infection were assessed with multivariable logistic regression analysis. Exploratory subgroup analyses further characterized specific 0.05% CHG scenarios.RESULTSAmong 14 participating institutions, 2,150 hydrophilic IPP cases were analyzed. Intraoperative 0.05% CHG was associated with a significantly higher rate of infection compared to using antimicrobials as an irrigant and dip (4.6% v 2.1%, p<0.001). Odds of infection were 2.07 times higher with intraoperative 0.05% CHG (CI 1.37-3.76, p=0.002). On subgroup analysis, the incidence of infection with use of 0.05% CHG as irrigant and dip was 4.5% compared to 3.8% when 0.05% CHG irrigation was used with antimicrobial dip. The rate of infection with 0.05% CHG use was 3.5% for primary surgeries and 12% for revision surgeries.CONCLUSIONSUse of 0.05% CHG with hydrophilic inflatable penile prostheses was associated with an elevated infection rate. For hydrophilic IPP surgery, caution with 0.05% CHG use is warranted pending additional prospective evaluation.
{"title":"Intraoperative 0.05% Chlorhexidine Gluconate Utilization Is Associated with an Increased Incidence of Infection in Hydrophilic Inflatable Penile Prosthesis Surgery: a Multi-institutional Cohort Study.","authors":"Samuel J Ivan,Elia Abou Chawareb,Muhammed Hammad,Michael Lesgart,Bryce Baird,Petar Bajic,David W Barham,Helen L Bernie,Raevti Bole,Paul Chung,Ketch Cowan,Zayda Dominick,Jacob Good,Sevann Helo,Michael H Hsieh,Brian H Im,Yash Kadakia,Tobias Kohler,Aaron C Lentz,Marcelo Mass-Lindenbaum,Allen F Morey,Vi Nguyen,Thairo Pereira,Paul Perito,Hossein Sadeghi-Nejad,Joshua Schammel,Anand Shridharani,Nicklas Sarantos,Alfredo Suarez-Sarmiento,J Nicholas Warner,Charles Welliver,Matthew Ziegelmann,Faysal A Yafi,Martin S Gross,Jay Simhan","doi":"10.1097/ju.0000000000004853","DOIUrl":"https://doi.org/10.1097/ju.0000000000004853","url":null,"abstract":"PURPOSEAvailable data is conflicting and limited regarding the antimicrobial effectiveness of 0.05% Chlorhexidine Gluconate (0.05% CHG) with hydrophilic inflatable penile prostheses (IPP). We utilized a large multi-institutional cohort to explore the relationship between intraoperative 0.05% CHG use and hydrophilic IPP infection.MATERIALS AND METHODSWe conducted a retrospective, multi-institutional review of patients who underwent hydrophilic IPP implantation. Consecutive cases involving intraoperative 0.05% CHG as an irrigant and/or dip were compared to a similar number of consecutive control cases without 0.05% CHG. The primary outcome was IPP explant for infection. Predictors of infection were assessed with multivariable logistic regression analysis. Exploratory subgroup analyses further characterized specific 0.05% CHG scenarios.RESULTSAmong 14 participating institutions, 2,150 hydrophilic IPP cases were analyzed. Intraoperative 0.05% CHG was associated with a significantly higher rate of infection compared to using antimicrobials as an irrigant and dip (4.6% v 2.1%, p<0.001). Odds of infection were 2.07 times higher with intraoperative 0.05% CHG (CI 1.37-3.76, p=0.002). On subgroup analysis, the incidence of infection with use of 0.05% CHG as irrigant and dip was 4.5% compared to 3.8% when 0.05% CHG irrigation was used with antimicrobial dip. The rate of infection with 0.05% CHG use was 3.5% for primary surgeries and 12% for revision surgeries.CONCLUSIONSUse of 0.05% CHG with hydrophilic inflatable penile prostheses was associated with an elevated infection rate. For hydrophilic IPP surgery, caution with 0.05% CHG use is warranted pending additional prospective evaluation.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"57 1","pages":"101097JU0000000000004853"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVETo evaluate the performance of the AUA 2025 guidelines stratification process in patients with microscopic hematuria (MH) to predict urothelial and renal cortical neoplasms and to assess the specific clinical components used in this stratification.METHODSThis retrospective study analyzed 4550 patients with asymptomatic MH, evaluated from 2010 to 2023 who underwent both imaging and cystoscopy. Patients were classified into risk groups based on the AUA 2025 guidelines to predict the presence of total neoplasms, specifically urothelial and renal cortical neoplasms and to validate the specific clinical components used in the guidelines.RESULTSAmong the 4550 patients the overall neoplasm incidence was 3.1%, with urothelial neoplasms at 1.5% and renal cortical neoplasms at 1.6% (1.3% angiomyolipomas and 0.35% non-AML renal masses). High-risk patients had a higher incidence of urothelial malignancy (3.8%) compared to intermediate-risk and low risk patients (0.8% and 0.2% respectively) while the incidence of renal neoplasms of any type was not significantly different across risk groups. Significant predictors of urothelial malignancies included age, male gender, smoking pack years, and urinary RBC count, validating the AUA 2025 guidelines. However, only male gender and smoking history but not degree of hematuria or pack years of smoking predicted non-AML renal tumors. In the recent amendment women were not classified as high risk based on age >60 but this study noted women >70 had an incidence of bladder cancer at 2.2%.CONCLUSIONThe AUA 2025 guidelines effectively stratify patients with MH into risk groups for urothelial cancer but not renal cortical neoplasms of any kind. Furthermore, the variables utilized in the construction of this model were also validated for urothelial cancers but not renal neoplasms. In this study women over 70 have an incidence of urothelial cancer of 2.2% suggesting females over 70 should be considered high risk. The lack of predictive value for renal cortical neoplasms suggests areas for guideline realignment, specifically the type and goal of renal imaging.
{"title":"Critical Analysis of the AUA 2020/2025 Microscopic Hematuria Guidelines to Predict Urothelial But Not Renal Cortical Neoplasms and Validation of the Individual Clinical Components in Risk Stratification for Urothelial Neoplasms But Not Renal Cortical Neoplasms.","authors":"Emeka Udedibia,Kenneth Solosky,Eric J Macdonald,Jacob Gaines,Karen Huang,Michael Diefenbach,Manish Vira,Simon J Hall","doi":"10.1097/ju.0000000000004854","DOIUrl":"https://doi.org/10.1097/ju.0000000000004854","url":null,"abstract":"OBJECTIVETo evaluate the performance of the AUA 2025 guidelines stratification process in patients with microscopic hematuria (MH) to predict urothelial and renal cortical neoplasms and to assess the specific clinical components used in this stratification.METHODSThis retrospective study analyzed 4550 patients with asymptomatic MH, evaluated from 2010 to 2023 who underwent both imaging and cystoscopy. Patients were classified into risk groups based on the AUA 2025 guidelines to predict the presence of total neoplasms, specifically urothelial and renal cortical neoplasms and to validate the specific clinical components used in the guidelines.RESULTSAmong the 4550 patients the overall neoplasm incidence was 3.1%, with urothelial neoplasms at 1.5% and renal cortical neoplasms at 1.6% (1.3% angiomyolipomas and 0.35% non-AML renal masses). High-risk patients had a higher incidence of urothelial malignancy (3.8%) compared to intermediate-risk and low risk patients (0.8% and 0.2% respectively) while the incidence of renal neoplasms of any type was not significantly different across risk groups. Significant predictors of urothelial malignancies included age, male gender, smoking pack years, and urinary RBC count, validating the AUA 2025 guidelines. However, only male gender and smoking history but not degree of hematuria or pack years of smoking predicted non-AML renal tumors. In the recent amendment women were not classified as high risk based on age >60 but this study noted women >70 had an incidence of bladder cancer at 2.2%.CONCLUSIONThe AUA 2025 guidelines effectively stratify patients with MH into risk groups for urothelial cancer but not renal cortical neoplasms of any kind. Furthermore, the variables utilized in the construction of this model were also validated for urothelial cancers but not renal neoplasms. In this study women over 70 have an incidence of urothelial cancer of 2.2% suggesting females over 70 should be considered high risk. The lack of predictive value for renal cortical neoplasms suggests areas for guideline realignment, specifically the type and goal of renal imaging.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"7 1","pages":"101097JU0000000000004854"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1097/ju.0000000000004843
Margaret S Pearle,Brian R Matlaga,Jodi A Antonelli,Thomas Chi,Ryan S Hsi,Sennett K Kim,Erin Kirkby,Bodo Knudsen,Kevin Koo,Naim M Maalouf,Vernon M Pais,Ann Paris,Kristina L Penniston,Kymora B Scotland,Lesley H Souter,Nicole Streeper,Gregory Tasian,Kyle D Wood,Justin B Ziemba
PURPOSEThis Guideline covers the surgical management of patients with ureteral and/or kidney stones and is intended for clinicians evaluating and managing patients with this disease. The summary presented herein represents Part II of the three-part series dedicated to Surgical Management of Kidney and Ureteral Stones. Please refer to Part III for additional information on this topic.MATERIALS AND METHODSThis systematic review was conducted in two planned stages, including a search for systematic reviews followed by a search for primary literature.OVID was used to systematically search MEDLINE and EMBASE databases for articles evaluating surgical management of kidney and ureteral stones. The Panel selected control articles that were deemed relevant and the articles were compared with the literature search strategy output. The methodologist then updated the strategy as necessary to capture all control articles. Databases were searched for studies published from January 2000 through May 2025 (week 20). In addition to the MEDLINE and EMBASE databases searches, reference lists of included systematic reviews and primary literature were scanned for potentially useful studies.RESULTSThe Panel addressed adult and pediatric patients with ureteral and/or kidney stones for whom surgical intervention may be indicated. Each statement herein addressed a particular patient scenario for which the choice of surgical intervention was reviewed and justified. In addition, the Panel reviewed and analyzed the utility of specific surgical techniques, technologies, or medications aimed at improving patient outcomes.CONCLUSIONSSelection of optimal treatment modalities for patients with kidney and/or ureteral stones is determined by patient factors, urinary tract anatomy, and stone characteristics and are guided by shared decision-making that additionally takes into account patient goals and preferences, resource availability, and physician expertise. This Guideline serves as a resource for clinicians and patients to provide the best available evidence on which to base discussions with patients in a shared decision-making process to arrive at appropriate treatment decisions.
{"title":"Surgical Management of Kidney and Ureteral Stones: AUA Guideline (2026) Part II: Evaluation and Treatment of Patients with Kidney and/or Ureteral Stones.","authors":"Margaret S Pearle,Brian R Matlaga,Jodi A Antonelli,Thomas Chi,Ryan S Hsi,Sennett K Kim,Erin Kirkby,Bodo Knudsen,Kevin Koo,Naim M Maalouf,Vernon M Pais,Ann Paris,Kristina L Penniston,Kymora B Scotland,Lesley H Souter,Nicole Streeper,Gregory Tasian,Kyle D Wood,Justin B Ziemba","doi":"10.1097/ju.0000000000004843","DOIUrl":"https://doi.org/10.1097/ju.0000000000004843","url":null,"abstract":"PURPOSEThis Guideline covers the surgical management of patients with ureteral and/or kidney stones and is intended for clinicians evaluating and managing patients with this disease. The summary presented herein represents Part II of the three-part series dedicated to Surgical Management of Kidney and Ureteral Stones. Please refer to Part III for additional information on this topic.MATERIALS AND METHODSThis systematic review was conducted in two planned stages, including a search for systematic reviews followed by a search for primary literature.OVID was used to systematically search MEDLINE and EMBASE databases for articles evaluating surgical management of kidney and ureteral stones. The Panel selected control articles that were deemed relevant and the articles were compared with the literature search strategy output. The methodologist then updated the strategy as necessary to capture all control articles. Databases were searched for studies published from January 2000 through May 2025 (week 20). In addition to the MEDLINE and EMBASE databases searches, reference lists of included systematic reviews and primary literature were scanned for potentially useful studies.RESULTSThe Panel addressed adult and pediatric patients with ureteral and/or kidney stones for whom surgical intervention may be indicated. Each statement herein addressed a particular patient scenario for which the choice of surgical intervention was reviewed and justified. In addition, the Panel reviewed and analyzed the utility of specific surgical techniques, technologies, or medications aimed at improving patient outcomes.CONCLUSIONSSelection of optimal treatment modalities for patients with kidney and/or ureteral stones is determined by patient factors, urinary tract anatomy, and stone characteristics and are guided by shared decision-making that additionally takes into account patient goals and preferences, resource availability, and physician expertise. This Guideline serves as a resource for clinicians and patients to provide the best available evidence on which to base discussions with patients in a shared decision-making process to arrive at appropriate treatment decisions.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"1 1","pages":"101097JU0000000000004843"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-18DOI: 10.1097/ju.0000000000004781
Tiziana Cotechini,Nathalia Kim,Charles C T Hindmarch,David M Berman,J Curtis Nickel,D Robert Siemens,Amber L Simpson,R Christopher Doiron
PURPOSEA comprehensive spatial immune profile of Hunner lesions (HLs) in interstitial cystitis/bladder pain syndrome (IC/BPS) is absent from the literature. Here, we leveraged imaging mass cytometry, a multiplex imaging platform, with novel computational pipelines to evaluate the immune in situ microenvironment of HL-IC/BPS.MATERIALS AND METHODSFormalin-fixed paraffin-embedded HL tissue samples retrospectively collected from 10 patients with HL-IC/BPS were stained using a cocktail of 20-metal conjugated antibodies designed to profile both the innate and adaptive immune system. Imaging data were acquired using the Hyperion Imaging System. Data were visualized and processed using computational machine learning pipelines to resolve general immune complexity and spatial relationships in HL.RESULTSMore than 174,000 cells were analyzed across these 10 patient samples. On average, macrophages were the most abundant cell type found in HL-IC/BPS, followed by CD4+ T cells, CD8+ T cells, and B cells. We observed distinct spatial neighborhoods of macrophage subtypes including tissue repair-like CD163+ macrophages and activated granzyme B+ macrophages within lesions. Computational analysis also demonstrated quantifiable methods to differentiate HL-IC/BPS patients based on differences in immune cell agglomeration within a lesion.CONCLUSIONSHere, we demonstrate the use of highly multiplexed imaging in combination with novel analysis pipelines as a feasible method to understand the spatial organization of HLs. This pilot study suggests that these methods will be useful to prospectively characterize and evaluate the local immune microenvironment in HL-IC/BPS and could uncover mechanisms of disease pathogenesis.
目的：文献中缺乏间质性膀胱炎/膀胱疼痛综合征（IC/BPS）患者Hunner病变（HLs）的综合空间免疫图谱。在这里，我们利用成像质量细胞术，一个多重成像平台，与新的计算管道来评估HL-IC/BPS的免疫原位微环境。材料与方法回顾性收集10例HL- ic /BPS患者的HL组织标本，采用20种金属偶联抗体对HL- ic /BPS进行染色。使用Hyperion成像系统获取成像数据。使用计算机器学习管道对数据进行可视化和处理，以解决HL的一般免疫复杂性和空间关系。结果在这10例患者样本中分析了超过17.4万个细胞。平均而言，巨噬细胞是HL-IC/BPS中最丰富的细胞类型，其次是CD4+ T细胞、CD8+ T细胞和B细胞。我们观察到巨噬细胞亚型的不同空间邻域，包括组织修复样CD163+巨噬细胞和活化的颗粒酶B+巨噬细胞。计算分析还证明了基于病变内免疫细胞聚集差异来区分HL-IC/BPS患者的量化方法。在这里，我们展示了使用高复用成像结合新的分析管道作为一种可行的方法来了解hl的空间组织。本初步研究表明，这些方法将有助于前瞻性地表征和评估HL-IC/BPS的局部免疫微环境，并可能揭示疾病的发病机制。
{"title":"Imaging Mass Cytometry Immune Profiling of Hunner Lesions in a Convenience Sample of Patients With Interstitial Cystitis/Bladder Pain Syndrome.","authors":"Tiziana Cotechini,Nathalia Kim,Charles C T Hindmarch,David M Berman,J Curtis Nickel,D Robert Siemens,Amber L Simpson,R Christopher Doiron","doi":"10.1097/ju.0000000000004781","DOIUrl":"https://doi.org/10.1097/ju.0000000000004781","url":null,"abstract":"PURPOSEA comprehensive spatial immune profile of Hunner lesions (HLs) in interstitial cystitis/bladder pain syndrome (IC/BPS) is absent from the literature. Here, we leveraged imaging mass cytometry, a multiplex imaging platform, with novel computational pipelines to evaluate the immune in situ microenvironment of HL-IC/BPS.MATERIALS AND METHODSFormalin-fixed paraffin-embedded HL tissue samples retrospectively collected from 10 patients with HL-IC/BPS were stained using a cocktail of 20-metal conjugated antibodies designed to profile both the innate and adaptive immune system. Imaging data were acquired using the Hyperion Imaging System. Data were visualized and processed using computational machine learning pipelines to resolve general immune complexity and spatial relationships in HL.RESULTSMore than 174,000 cells were analyzed across these 10 patient samples. On average, macrophages were the most abundant cell type found in HL-IC/BPS, followed by CD4+ T cells, CD8+ T cells, and B cells. We observed distinct spatial neighborhoods of macrophage subtypes including tissue repair-like CD163+ macrophages and activated granzyme B+ macrophages within lesions. Computational analysis also demonstrated quantifiable methods to differentiate HL-IC/BPS patients based on differences in immune cell agglomeration within a lesion.CONCLUSIONSHere, we demonstrate the use of highly multiplexed imaging in combination with novel analysis pipelines as a feasible method to understand the spatial organization of HLs. This pilot study suggests that these methods will be useful to prospectively characterize and evaluate the local immune microenvironment in HL-IC/BPS and could uncover mechanisms of disease pathogenesis.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"75 1","pages":"101097JU0000000000004781"},"PeriodicalIF":0.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1097/ju.0000000000004818
Spencer Tingey,David Gangwish,Brock O'Neil
{"title":"Data Grows in Support of Micro-Ultrasound for Prostate Cancer Diagnosis.","authors":"Spencer Tingey,David Gangwish,Brock O'Neil","doi":"10.1097/ju.0000000000004818","DOIUrl":"https://doi.org/10.1097/ju.0000000000004818","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"1 1","pages":"101097JU0000000000004818"},"PeriodicalIF":0.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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