To investigate how patient-specific factors, including race and socioeconomic status, impact time to treatment initiation (TTI) for patients with small renal masses (SRMs).
We retrospectively reviewed 275 patients with SRMs ≤ 4 cm at Atrium Health Carolinas Medical Center who underwent treatment for their renal mass. TTI was defined by the time between office visit (TTI-OV) or between initial imaging (TTI-Imaging) and procedure date. Statistical analysis was employed to determine patient-specific factors associated with TTI.
We found that TTI was significantly associated with race as Black patients experienced longer TTI than non-Hispanic White patients (OV: HR = 0.637, 95% CI [0.479–0.848], p = 0.0048; Imaging: HR = 0.541, 95% CI [0.402–0.727], p = 0.0002). TTI, however, was not significantly associated with socioeconomic status as defined by Area Deprivation Index, income or insurance status. TTI-OV was also significantly associated with procedure year, and TTI-Imaging was associated with procedure year, Charlson Comorbidity Index (CCI) and tumour size when first seen on imaging. On multivariable analysis, TTI-Imaging was not independently associated with race (p = 0.1775), suggesting procedure year, CCI and tumour size are more significant predictors of TTI.
Black patients experienced a treatment delay from initial clinical presentation to procedure, but treatment delays from initial imaging identification to procedure may be tied more strongly to clinical factors.
The objective of this study is to evaluate the safety and efficacy of Rezūm water vapour energy therapy (WAVE) in Japanese patients with benign prostatic hyperplasia (BPH) continuing antithrombotic therapy and to validate the Okayama University Modified Clavien-Dindo classification (OU-mCD) for perioperative hematuria.
We retrospectively analysed 80 consecutive patients who underwent WAVE from August 2023 to July 2024, including 37 (46.2%) continuing antithrombotic therapy perioperatively. Hematuria within 30 days was graded using conventional Clavien-Dindo classification and the OU-mCD, a novel classification focusing on intervention necessity. We assessed clinically significant hematuria (Grade ≥ Ib), catheter-free rate, prostate volume reduction and haemoglobin change.
Clinically significant hematuria occurred in 21.6% (8/37) of patients continuing antithrombotic therapy versus 4.7% (2/43) without (p = 0.038). All 10 Grade ≥ Ib cases occurred during hospitalization with the catheter in place and were managed conservatively with continuous bladder irrigation (median 1 day); none required transfusion or surgical reintervention. Only one patient required temporary drug discontinuation. Treatment efficacy did not differ by antithrombotic status: 86.2% achieved PVR < 50 ml with 44% mean prostate volume reduction. Multivariate analysis identified antithrombotic therapy as the sole independent risk factor for Grade ≥ Ib hematuria (OR 5.46, 95% CI 1.06–28.16, p = 0.042).
WAVE can be safely performed with continued antithrombotic therapy. Whereas Grade ≥Ib hematuria occurred in 25% of antiplatelet/anticoagulant users (vs. 5% without), 75% had no significant bleeding, and all complications were managed conservatively without transfusion. The OU-mCD provides precise complication stratification. These findings suggest outpatient procedures may be feasible with appropriate patient selection.
The purpose of this study is to investigate the impact of Glucagon-like peptide-1 receptor agonists (GLP-1RAs) use on 90-day postoperative outcomes and overall survival following partial nephrectomy (PN) for renal cell carcinoma (RCC), where type 2 diabetes mellitus (T2DM) is a common comorbidity.
The TriNetX database was used to retrospectively identify T2DM patients who underwent PN. Patients prescribed GLP-1RAs were identified and matched in a 1:1 ratio with control patients who were not prescribed GLP-1RAs based on baseline characteristics, comorbidities, metformin and insulin prescription, and renal function laboratory values. For 90-day postoperative adverse events, risk difference, risk ratio and odds ratio with 95% confidence intervals were calculated. Kaplan–Meier analysis, log-rank tests and multivariable Cox Proportional Hazards model were performed to measure the effect of GLP-1RAs use on overall survival.
Use of GLP-1RAs was associated with lower odds of acute kidney injury (odds ratio [OR] = 0.712), arrhythmia (OR = 0.725), readmission (OR = 0.8) and ileus (OR = 0.336) compared to the non-GLP-1RAs group (p < 0.05 for each). Kaplan–Meier analysis and log-rank tests demonstrated improved 2-year (p = 0.002) and 3-year (p = 0.001) overall survival among patients prescribed GLP-1RAs compared to those who were not.
Use of GLP-1RAs was associated with reduced incidence of 90-day postoperative complications, such as acute kidney injury, arrhythmia, readmission and ileus, potentially contributing to improved overall survival. These results align with ongoing studies investigating the broader benefits of the use of GLP-1RAs.
While early outcomes after pyeloplasty are well-documented, long-term split renal function (SRF) stability, particularly beyond puberty, remains unclear. This study evaluates SRF after prepubertal pyeloplasty and identifies factors associated with late deterioration.
A retrospective review included paediatric patients who underwent pyeloplasty between 2000 and 2025. Exclusion criteria were solitary kidney, missing imaging, congenital anomalies or prior pyeloplasty. Patients were categorised into two groups: Group 1 (no deterioration) and Group 2 (late deterioration after puberty), based on ≥5% decrease in SRF. Clinical, surgical and imaging parameters were compared among groups using Chi-square, Fisher's exact and Mann–Whitney U tests, with multivariate logistic regression to identify predictors of late deterioration.
Out of 1493 patients, 191 were included: 152 (79.6%) in Group 1 and 39 (20.4%) in Group 2. Group 2 patients were younger at surgery, had more frequent renal pelvis reduction and persistent hydronephrosis at 1-year follow-up (p < 0.001). Multivariate analysis identified renal pelvis reduction (odds ratio [OR] = 9.82, 95% confidence interval [CI]: 3.551–37.799, p < 0.001) and non-resolution of hydronephrosis (OR = 4.811, 95% CI: 1.766–13.1, p = 0.002), as late deterioration predictors. Older age at surgery (OR = 0.958, 95% CI: 0.942–0.975, p < 0.001) and higher final SRF (OR = 0.905, 95% CI: 0.855–0.958, p < 0.001) were protective against deterioration.
SRF may deteriorate after puberty despite initial post-operative stability. Renal pelvis reduction, persistent hydronephrosis at 1 year and younger age at surgery are associated with increased risk of deterioration.
This study aimed to perform a risk analysis of any prostate cancer (Pca) and of clinically significant prostate cancer (csPCa) in a contemporary cohort of prostatic biopsies.
We conducted a retrospective analysis of patients who underwent prostate biopsies in our centre between December 2020 and December 2022. We calculated Pca and csPCa rate (ISUP grade ≥2). Univariate and multivariate regression models were constructed to assess independent predictive factors for Pca and csPCa. We used χ2 automatic interaction detection (CHAID) for decision tree analysis.
We included 255 patients in the analysis, of whom 69.8% had positive biopsies for Pca and 36.9% for csPCa. Multivariate analysis found PSA density (PSAd) (OR = 1.001) (1.000; 1.001), PIRADS score (OR = 1.393) (1.234; 1.571) as independent predictive factors of csPCa. For the detection of any PCa, CHAID analysis revealed that patients with PIRADS score ≤4 doubled the risk of negative biopsies (from 22.6% to 54.3%) when the prostate volume was >46 mL.
For patients with a PIRADS ≤4, a large prostate volume (>46 mL) was a predictor of negative biopsies, independently of PSAd. MRI interpretation and targeting in these patients should therefore be performed with particular caution.
The purpose of this study is investigate the clinical outcomes of men with benign prostatic hyperplasia (BPH) and bladder stones treated concomitantly with Aquablation and bladder stone removal in an international, multi-institutional cohort.
We performed a retrospective analysis of men who underwent Aquablation between 2018 and 2024. Patients were divided into two cohorts: men with bladder stones and those without. Outcomes assessed included baseline demographics and variables (medication use, prostate volume, prior BPH surgery), operative characteristics (OR time, transfusion requirement, complications), and functional outcomes were measured by the International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax) and PVR at regular intervals over 24 months.
A total of 1885 men were analysed, including 60 men with bladder stones and 1825 without. Patients with bladder stones had higher rates of prior BPH surgery (15% vs. 5.5%, p = 0.015) and pre-operative urinary retention (28.3% vs. 14.8%, p = 0.004) as well as larger prostate volumes (98.6 ml vs. 77 ml, p < 0.0001). Total operative time was longer in the bladder stone group (76.5 mins vs. 55.0 mins, p < 0.001), but there were no significant differences in Aquablation time or bleeding complications including transfusions. There was also no difference in improvements in IPSS, Qmax and PVR post-operatively.
This study demonstrates that Aquablation is safe and effective in the management of BPH regardless of concomitant bladder stone treatment.
While earlier decompression after spinal cord injury (SCI) is linked to better motor recovery, its impact on bladder and sexual function remains unexplored. Our objective was to determine if time to surgical decompression is associated with bladder and sexual function.
We conducted a retrospective cohort study using the prospectively collected Canadian Rick Hansen SCI Registry. Primary exposure was time to surgical decompression. Primary outcome was abnormal bladder function defined by use of catheters or any incontinence at 1-year. Secondary outcomes were sexual function and motor score. Adjusted logarithmic regression models were used.
One thousand thirty-eight participants met inclusion criteria. Median time to surgical decompression was 25 (IQR17–50) hours, and 46% (475/1038) had early decompression (<24 h). There were 63% (650/1038) who had evidence of abnormal bladder function at 1-year. On multivariate regression, time to decompression was not significantly related to abnormal bladder function (OR 1.00, 95% CI 1.00–1.01, p = 0.38); older age (OR 1.13, 95% CI 1.03–1.23, p = 0.01) and worse ASIA score (ASIA A OR 16.35, p < 0.01, ASIA B OR 5.12, p < 0.01 and ASIA C OR 2.23, p < 0.01 all relative to ASIA D) were significantly associated with abnormal bladder function. These results were similar in several sensitivity analyses. Time to decompression was also not significantly associated with sexual function or motor score at 1-year.
A shorter time to surgical decompression after SCI was not associated with improved bladder or sexual function outcomes; however, older age and a more complete injury were significant predictors.
The aim of this study is to evaluate the impact of ureteric stent diameter on stent-related symptoms and early urological complications in kidney transplant recipients.
A single-centre randomised controlled trial that enrolled 70 kidney transplant recipients to receive either a 4.8 Fr or 6 Fr ureteric stent allocated at a 1:1 ratio was conducted. Stent-related symptoms and patient-reported outcomes were assessed using the Ureteral Stent Symptom Questionnaire (USSQ) and a visual analogue scale (VAS) for pain. Early postoperative complications—including urinary leakage, ureteric obstruction and urinary tract infection (UTI)—were recorded.
The 4.8 Fr stents were associated with significantly fewer stent-related symptoms and lower USSQ scores than 6 Fr stents (47.0 ± 4.5 vs. 53.9 ± 4.2; p < 0.001). Patients who received a 4.8 Fr stent experienced lower pain intensity than those who received a 6 Fr stent (VAS 1.4 ± 0.7 vs. 2.2 ± 0.8; p < 0.001). Rates of urinary leakage, ureteric obstruction and UTI were comparable between the two groups.
The 4.8 Fr ureteric stents reduce stent-related symptoms and postoperative pain while demonstrating a similar early safety profile to 6 Fr stents. These findings support the use of smaller-calibre stents to improve postoperative comfort following kidney transplantation.
To evaluate the efficacy and safety of adding 0.1% tranexamic acid (TXA) to irrigation fluid in reducing perioperative blood loss during mini-percutaneous nephrolithotomy (mini-PCNL).
In this prospective, randomised study, 40 patients undergoing mini-PCNL were allocated to receive irrigation fluid containing either 0.1% TXA (n = 20) or distilled water (placebo; n = 20). The outcomes assessed included changes in haemoglobin, estimated blood loss, operative duration, irrigation volume, length of hospital stay, transfusion requirements, stone clearance and TXA-related adverse events.
Baseline characteristics were comparable between the two groups. The TXA group had significantly less haemoglobin decline (0.5 g/dl vs. 1.5 g/dl) and lower estimated blood loss (91.7 ml vs. 169.0 ml) compared with the placebo group (both p < 0.05). Operative time and hospital stay were also shorter in the TXA group (p < 0.05). Transfusion rate and irrigation volume were lower in the TXA group, while stone clearance rates were comparable between the groups (90% vs. 85%; p = 0.633). No TXA-related adverse events were observed.
The addition of 0.1% TXA to irrigation fluid during mini-PCNL significantly reduces perioperative blood loss and appears to be safe in this pilot cohort, without increasing complications observed in the study.
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