Frontiers in urology最新文献

Aim: The diagnosis of prostate cancer and prostatitis becomes challenging when using biparametric Magnetic Resonance (MR) images. This research investigates deep learning models to assess their capability for improving diagnostic accuracy and assisting radiologists.

Methods: This retrospective study analyzed 153 patients who received histopathological diagnoses of prostate cancer or prostatitis between January 2017 and December 2023. Patients were categorized according to PI-RADS scores, and both T2A and ADC-DWI (Apparent Diffusion Coefficient-Diffusion-Weighted Imaging) sequences were examined. Expert radiologists labeled the images prior to lesion detection with the Faster R-CNN (Faster Region-based Convolutional Neural Network) model. Nine different classification models were trained using normal and augmented datasets to evaluate their performance. Model reliability was further assessed through cross-validation and statistical significance testing.

Results: The Faster R-CNN model achieved 96% accuracy (95% CI: 93.2-98.8%) for P5 and 99% accuracy (95% CI: 96.7-100%) for prostatitis in T2A sequences, and 90% accuracy (95% CI: 85.4-94.6%) for P5 and 97% accuracy (95% CI: 93.8-100%) for prostatitis in ADC-DWI sequences. However, the model failed to effectively detect P4 lesions (0% sensitivity in T2A and 30% in ADC-DWI). The model demonstrated comparable performance to expert radiologists, with no significant difference in overall P5 detection (p > 0.05), and Cohen's kappa indicated substantial agreement (κ = 0.86). The classification models achieved up to 97% accuracy with InceptionV3 in T2A sequences and up to 99% accuracy with DenseNet201 in ADC-DWI sequences. To further evaluate discriminative performance, AUROC values were calculated for all classification models. In T2A sequences, AUROC scores were DenseNet201 (0.98), EfficientNetV2L (0.99), InceptionV3 (0.99), MobileNetV2 (0.92), NASNetLarge (0.83), ResNet50 (0.76), VGG16 (0.98), VGG19 (0.97), and Xception (0.96). In ADC-DWI sequences, AUROC values were DenseNet201 (0.99), EfficientNetV2L (0.96), InceptionV3 (0.99), MobileNetV2 (0.82), NASNetLarge (0.90), ResNet50 (0.64), VGG16 (0.96), VGG19 (0.86), and Xception (0.97), reinforcing the superior discriminative ability of DenseNet201 and InceptionV3 across modalities.

Conclusion: The deep learning models demonstrated promising diagnostic capabilities, comparable to radiologists, in distinguishing prostatitis and P5 prostate cancer lesions. Overall, the findings suggest that AI-based diagnostic tools hold potential as clinical decision support systems.

Purpose: Upper urinary tract urothelial carcinoma (UTUC) is an uncommon malignancy of the urogenital tract with a wide range of clinical outcomes. While prognostic factors for bladder-based UC are established, less is known about tumors in other locations and the impact of socioeconomic disparities. This study uses a large national database to identify key demographic, clinical, and socioeconomic predictors of overall survival in UC patients, focusing on the primary tumor site.

Methods: We conducted a retrospective analysis of 12,300 patients diagnosed with UC of the kidney and renal pelvis between 2004 and 2020 from the National Cancer Database (NCDB). Multivariable Cox proportional hazards regression was used to analyze the association between overall survival and factors including patient demographics, tumor characteristics, primary tumor site, and socioeconomic status.

Results: The cohort was predominantly male (59%) and White (91%), with a mean age of 71 at diagnosis. Multivariable analysis identified several factors significantly associated with survival. Renal pelvis tumors, the most common primary site (84.9%), were associated with significantly improved survival (HR = 0.84; 95% CI: 0.8-0.9; p<0.001). Compared to males, females exhibited a 15% lower hazard of death (HR = 0.85; 95% CI: 0.81-0.90; p<0.001). Factors associated with worse survival included a higher Charlson-Deyo comorbidity score (HR = 1.51; 95% CI: 1.39-1.65; p<0.001) and advanced NCDB tumor stage. Socioeconomically, patients with higher income (HR = 0.82; 95% CI: 0.75-0.90; p<0.001) and private insurance or Medicare (HR = 0.70; 95% CI: 0.57-0.87; p<0.001) had improved survival. Adjuvant chemotherapy was associated with a lower hazard of death (HR = 0.84; 95% CI: 0.75-0.95; p=0.007), whereas primary radiation therapy was associated with a higher hazard of death (HR = 1.69; 95% CI: 1.54-1.86; p<0.001).

Conclusion: This large-scale analysis identifies the primary tumor site as a key prognostic factor in UC, with renal pelvis tumors demonstrating more favorable survival. The study also confirms the significant influence of comorbidity and tumor stage while uniquely highlighting that socioeconomic factors, such as income and insurance, are powerful predictors of outcome. These findings underscore the need for optimized, site-specific treatment strategies and concerted efforts to address healthcare inequities in the management of upper tract UC.

Background: Autologous buccal mucosa cell transplantation has emerged as a promising treatment strategy for urethral stricture disease. However, ambiguity has persisted regarding the optimal cell type and culture conditions that aid successful urethral repair. Clinical study of our previously reported cell-based endoscopic approach, the buccal epithelium expanded and encapsulated in scaffold-hybrid approach to urethral stricture (BEES-HAUS), demonstrated durable epithelial regeneration and long-term urethral patency. The present work provides mechanistic insights supporting the BEES-HAUS approach of combining two-dimensional (2D) monolayer-cultured fibroblast-like cells and three-dimensional (3D) thermo-responsive gelation polymer (Festigel)-cultured cells.

Methods: Human buccal tissues (n=22) were cultured in two methods; one portion using the monolayer method (2D), and the other in 3D using Festigel. Flow cytometry for phenotype markers and ELISA for IGF-1 were carried out.

Results: 3D Festigel-cultured cells acquired an epithelial phenotype, with AE1/AE3 expression up to day 21, while 2D cultures yielded fibroblast-like CD140b-positive/AE1-AE3-negative cells. IGF-1 secretion was significantly higher in 2D cultures than 3D Festigel (p < 0.05), indicating a supportive paracrine role. These findings explain the complementary contribution of epithelial integration and IGF-1-mediated support observed as successful clinical outcome of the BEES-HAUS procedure.

Conclusion: This study, a first of its kind, clarifies the rationale and advantages of combining 3D Festigel-expanded epithelial cells with the paracrine effect of IGF-1-secreting 2D fibroblast-like cells in a single transplantation strategy, thereby explaining the successful clinical outcomes reported in BEES-HAUS. Further research on this hybrid cell combination is recommended to expand this approach for regenerating and repairing other tissues and organs.

Background and objective: To compare hexaminolevulinate (HAL) blue light cystoscopy (BLC) with white light cystoscopy (WLC) in the detection of bladder cancer.

Methods: Patients received intravesical HAL (Hexvix^®) and underwent WLC before randomization to undergo high-definition BLC (System blue). Lesions identified in either WLC or BLC were evaluated by a blinded panel. The primary efficacy endpoint was the proportion of patients with histology-confirmed tumors (Ta, T1, or CIS) and with at least one such tumor found by BLC but not by WLC. The secondary endpoints included the detection of CIS, lesion detection rates, false-positive rate, and safety.

Results: Of the 158 (160 screened patients) enrolled patients, 120 underwent WLC and were randomized (6 WLC, 114 BLC), and 97 were diagnosed with NMIBC. The mean age was 65.30 ± 12.18 years. Out of the 114 patients, 13 (11.4%) suffered from CIS; 84.6% (11/13) were detected with additional lesions by BLC; and 61.5% (8/13) were diagnosed solely by BLC. Compared with WLC, the proportion of patients with additional bladder cancer lesions detected by HAL BLC was 43.3% [(33.27%, 53.75%), p < 0.0001]. The proportion of patients with CIS lesions detected by HAL BLC and not by WLC was 9.6% (4.9%, 16.6%). The detection rates for CIS, Ta, T1, and T2-T4 tumors were 94.7%, 100%, 98.2%, and 100% for BLC and 42.1%, 76.1%, 91.2%, and 100% for WLC, respectively. The false-positive rates were 23.2% (19.2%, 27.7%) and 16.0% (11.9%, 20.8%) for BLC and WLC, respectively. A total of 95 patients (60.1%) reported 200 cases of AE, with 9 AEs being drug-related (fever, bladder pain, etc.). Nine device deficiencies (5.7%) occurred (eight quality issues and one device failure). No AEs and SAEs led to discontinuation.

Conclusions: In the setting of modern high-definition equipment, HAL BLC significantly improves the detection of bladder cancer with favorable safety.

Background: Female urethral diverticulum (UD) is a rare and often underdiagnosed condition that mimics other lower urinary tract disorders, leading to diagnostic delays. This study evaluated the clinical presentation, diagnostic accuracy, and surgical outcomes of methylene blue-assisted cystourethroscopy as an adjunct tool in confirming and localizing UD.

Methods: Fifteen female patients suspected of UD between 2015 and 2025 were retrospectively reviewed. All underwent cystourethroscopy with intraoperative methylene blue dye injection. Diagnostic findings were correlated with final histopathology, and surgical outcomes were assessed following transvaginal diverticulectomy.

Results: Twelve patients (80%) had histologically confirmed UD, while three had non-diverticular lesions (two Skene's gland cysts and one vaginal mucosa cyst). The methylene blue test was positive in 11 of 12 UD cases, yielding 91.7% sensitivity, 100% specificity, and 93.3% overall diagnostic accuracy. Most diverticula were mid-urethral (66.6%). Postoperatively, 83.3% achieved complete symptom resolution, while recurrence (16.7%) and fistula (8.3%) were successfully managed. No new stress incontinence or urethral stricture occurred.

Conclusion: Methylene blue-assisted cystourethroscopy is a simple, accurate, and low-cost adjunct that enhances intraoperative diagnosis and localization of female UD. It may be helpful in resource-limited settings. However, its role remains adjunctive, as it cannot replace MRI in defining complex anatomy. The small sample size, retrospective design, and inconsistent imaging represent key limitations. Larger prospective studies are needed to validate these findings.

[This corrects the article DOI: 10.3389/fruro.2025.1698789.].

Background: Urolithiasis poses a significant health risk to adolescents worldwide, yet information on its burden and trends is limited. This study analyzed the evolving patterns of urolithiasis among 10-24-year-olds globally, regionally, and nationally from 1990 to 2021.

Methods: This study predicted the global burden of diseases and investigated urolithiasis incidence and disability-adjusted life-years (DALYs) in 10-24-year-olds. We reported cases, rates per 100,000, and AAPCs globally, regionally, and nationally. We explored trends across age groups, sexes, and SDI categories, using Joinpoint regression to identify the year with the most significant global trend shift.

Results: The global incidence of urolithiasis among adolescents and young adults aged 10 - 24 years has increased modestly, from 321.5 per 100,000 in 1990 to 342.6 per 100,000 in 2021, with an average annual percent change (AAPC) of 0.2. A significant upward shift was observed in 2009. Regionally, Tropical Latin America saw the largest increase, with a rise from 155.1 per 100,000 in 1990 to 296.4 per 100,000 in 2021, and an AAPC of 2.07. In contrast, East Asia experienced the most significant decline, dropping from 214.2 per 100,000 in 1990 to 140.2 per 100,000 in 2021, with an AAPC of -1.37. Nationally, Brazil showed the highest increase, with an AAPC of 2.14, while the Russian Federation had the highest incidence in 2021, at 812.7 per 100,000. The middle-SDI quintile countries saw the largest increase in incidence, with an AAPC of 0.45. However, countries with high to middle and high SDI scores demonstrated a decrease in incidence. From 1990 to 2021, the incidence of urolithiasis increased more rapidly among females than males, with an AAPC of 0.26 and 0.16 respectively. By 2021, there were 6,467,487 cases globally, 57.8% of which were in males. The most significant increase in incidence was observed among those aged 20 - 24 years, with an AAPC of 0.29.

Conclusions: The global burden of urolithiasis in adolescents and youth is a significant health issue requiring international collaboration for better management. Enhancing diagnostic tools and implementing effective prevention and treatment methods are crucial.

Introduction: Urolithiasis, also known as renal lithiasis or nephrolithiasis, is an increasingly relevant urological pathology worldwide.

Objective: To estimate the global prevalence of urolithiasis through a systematic review (SR) with meta-analysis, and to systematically investigate methodological sources of heterogeneity in reported prevalence, including differences according to diagnostic methods, sex, and geographical regions.

Methodology: A SR followed PRISMA guidelines adapted for prevalence studies, searching SCOPUS, Web of Science, PubMed, and EMBASE. Observational studies were included in reporting the frequency of urolithiasis diagnosed by ultrasound, tomography, or self-report. A meta-analysis of proportions was performed using a random-effects model with double arcsine transformation. Subgroup analyses by diagnostic method, sex, sampling strategy, and geographical region were conducted. Additionally, meta-regression was conducted to analyze the influence of publication year on prevalence.

Results: In the combined analysis of 22 studies encompassing 1, 276, 826 participants, the estimated global prevalence of urolithiasis was 10.85% (95% CI: 8.76-13.14%). Considerable heterogeneity was observed (I² = 100%). Subgroup analyses revealed that diagnostic methods substantially influenced estimates: ultrasound 8.71% (95% CI: 5.74-12.23%), computed tomography 7.83% (95% CI: 7.12-8.60%), and self-report 13.28% (95% CI: 9.98-16.98%). Probabilistic sampling yielded 8.59% (95% CI: 6.34-11.14%) versus non-probabilistic 12.24% (95% CI: 9.32-15.50%). Prevalence was higher in males (12.93%) than females (8.91%). Regional variation ranged from 22.3% (Africa) to 8.3% (North America). Meta-regression showed publication year had no significant effect when adjusted for methodological factors (p = 0.1304).

Conclusions: Urolithiasis affects approximately 11% of the global population, constituting a public health problem requiring comprehensive preventive, diagnostic, and therapeutic actions. The substantial heterogeneity is largely explained by methodological factors, particularly diagnostic methods and sampling strategies. This highlights the critical importance of standardizing diagnostic and recruitment criteria to obtain comparable measurements for guiding health policies and future research.

Objective: This study investigates the factors influencing Chinese parents' decision to pursue circumcision for their children aged 6-12 years and analyzes the role of the Internet and media in the popularization of related scientific knowledge.

Methods: Based on retrospective data from the National Children's Regional Medical Single Center from 2015 to 2024, along with a questionnaire survey and literature analysis.

Results: The study found a significant increase in clinic visits (p = 0.000, r = 0.967) and circumcision procedures (p = 0.003, r = 0.831) among children with phimosis over the past decade. Circumcision is no longer entirely dependent on medical professional advice, but is influenced by a wider range of informational and sociocultural factors. Parents' trust in online medical information (OR = 6.054, 95% CI 1.027-35.683, p = 0.047) and prolonged exposure to media content recommending surgery (OR = 7.500, 95% CI 1.481-37.974, p = 0.015) were independent risk factors contributing to their decision. In contrast, fear of surgical risk (OR = 0.239, 95% CI 0.059-0.965, p = 0.044), anesthesia, high costs, and long recovery times were key deterrents. Further validation of these independent risk factors revealed that internet and social media platforms (e.g., Baidu, Xiao hongshu, and Shake) had a significant impact on parental decision-making through algorithmic recommendations and emotional content, creating an "opinion dominance effect."

Conclusion: The study reveals the complexity of parental decision-making and emphasizes the need to enhance the dissemination of scientific information to mitigate the impact of misleading content on medical decision-making.

Purpose: To explore the factors influencing prostate cancer screening willingness among the Chinese male population.

Methods: This is a qualitative study that adopted a phenomenological approach. Purposive sampling was used to recruit 21 males (aged 48-81 years, with a mean age of ~57 years) from the health examination center of a tertiary hospital in Shenyang, China. Semi-structured face-to-face interviews were verbatim transcribed and independently cross-checked by two Master's-level researchers. Data analysis was performed using MaxQDA ver.10 software and followed Colaizzi's phenomenological analysis steps.

Results: Deductive analysis identified three core themes aligned with the Theory of Planned Behavior (TPB): Attitudes toward the Behavior (getting screened for the sake of family, primary prevention actions, meaningless, fear of the result, and don't want family members to worry), subjective norm (family members, friends, and colleagues, and health professionals), and control beliefs (cost and insurance, limited understanding of the disease, no symptoms, unfamiliar with the PSA test, doubt screening, health examination package setting, and believe that cancer is incurable).

Conclusions: The study highlights the complex and unique factors influencing willingness to undergo prostate cancer screening in China. The findings provide insights for developing targeted interventions to address the challenges of insufficient prostate cancer screening, particularly by enhancing health professional guidance and addressing financial barriers.