Frontiers in urology最新文献

We conducted a prospective, single-center study (IRB 17/2025) to validate an AI-enabled, computer-assisted semen analyzer (LensHooke^® X1 PRO) operated by third- and fourth-year urology residents for the perioperative assessment of men undergoing loupe-assisted varicocelectomy at the University of Catania. The analyzer captured conventional and kinematic semen parameters according to the World Health Organization (WHO) 6th edition the day before and 3 months after surgery. In 42 patients (median age 31.5 years), the computer-assisted semen analysis (CASA) produced rapid, standardized readouts and showed statistically significant postoperative improvements across multiple parameters (p < 0.05). These findings support its concordance with manual analysis and underscore the value of integrating AI-based semen analysis into residency training to enhance accuracy, efficiency, and clinical decision-making in male infertility care.

Primary small cell neuroendocrine carcinoma (SCNEC) of the ureter is an exceptionally rare and aggressive malignancy, characterized by rapid progression and poor prognosis. Evidence regarding treatment with immune checkpoint inhibitors (ICIs) combined with neoadjuvant chemotherapy remains limited. We report the first documented case of ureteral SCNEC treated with a multimodal strategy incorporating programmed death-ligand 1 (PD-L1) inhibitors. A 57-year-old woman presented with a 15-day history of gross hematuria and 4 days of progressive left flank pain. Imaging revealed a left distal ureteral mass with hydronephrosis and suspected iliac lymphadenopathy. Stage IV high-grade urothelial carcinoma with small cell neuroendocrine differentiation of the ureter with regional lymph node metastases, confirmed by histopathology and immunohistochemistry (synaptophysin+, CD56+, Ki67 >75%). The patient received four cycles of neoadjuvant etoposide plus carboplatin chemotherapy, followed by radical left nephroureterectomy with bladder cuff excision. Adjuvant therapy included intravesical pirarubicin and six cycles of dual PD-1 blockade with toripalimab and vedicitumab. Post-neoadjuvant imaging showed a 60% reduction in tumor size. Pathology revealed R0 resection with marked tumor regression (Ki67 reduced to 40%). No recurrence was observed at 12-month follow-up. This case demonstrates the potential efficacy of integrating ICIs with standard treatment for advanced ureteral SCNEC. The durable response observed underscores the need for further research into early immunotherapy use and biomarker-guided therapeutic strategies.

Focal therapy (FT) for localized prostate cancer (PCa) has evolved into a precision-based alternative to radical treatments, aiming to eradicate clinically significant disease while minimizing functional morbidity. This review provides an updated and critical synthesis of the current landscape of FT, emphasizing the central role of multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy in patient selection, treatment planning, and post-therapy evaluation. mpMRI enables accurate lesion characterization, identification of index lesions, and tailored ablation with energy sources such as high-intensity focused ultrasound (HIFU), cryotherapy, irreversible electroporation (IRE), vascular-targeted photodynamic therapy (VTP), and interstitial laser therapy (ILT). Across modalities, continence preservation exceeds 90%, and erectile function is maintained in up to 100% of patients, underscoring the functional safety of FT. While current evidence supports FT as an oncologically sound option for low- and select intermediate-risk disease, data from phase III trials remain scarce. Emerging strategies integrating androgen deprivation therapy (ADT) with FT show promise in enhancing tumor control, particularly in high-risk, large-volume, or anatomically complex cases. Preliminary studies suggest synergistic benefits without increasing toxicity, though definitive long-term evidence is lacking. This review highlights how the convergence of advanced imaging, ablative technology, and systemic modulation may redefine the therapeutic paradigm of localized PCa. Further prospective, comparative trials are essential to establish the optimal combination strategies, refine patient selection, and confirm durable oncological and functional outcomes.

Introduction: Managing large renal stones with minimally invasive techniques is challenging, particularly in achieving optimal stone clearance. This report highlights the use of Retrograde Intrarenal Surgery (RIRS) combined with Combined Direct In-Scope Suction (DISS), Flexible and Navigable Ureteral Access Sheath (FANS), and thulium laser as an innovative approach to managing a complex staghorn stone.

Materials and method: A 39-year-old male presented with left flank pain and hematuria for three weeks. Imaging revealed a large staghorn stone in the left kidney (2.8 x 1.5 x 4.3 cm, 1000-1200 HU) alongside smaller stones (0.5-1 cm) with associated grade II hydronephrosis and suspected ureterovesical junction stricture. RIRS was performed with a thulium laser and DISS and FANS to optimize visualization and enable efficient stone debris removal. Postoperative imaging revealed a single residual fragment (10 x 7 mm), resulting in a stone-free rate of 96.2%.

Discussion: The integration of DISS and FANS in RIRS enhances procedural efficacy by maintaining a clear field of view and facilitating real-time removal of stone fragments. This approach proved to be effective in managing a large renal stone with minimal invasiveness, offering advantages such as reduced operative challenges and improved outcomes. This technique demonstrates the potential for RIRS as a viable alternative in selected scenarios.

Conclusion: RIRS combined with DISS and FANS represents a promising method for managing complex renal stones, achieving high stone-free rates with minimal complications.

Introduction: Prostate cancer (PCa) is a leading cause of male cancer mortality, with metastasis and immune evasion posing major therapeutic challenges. DOCK3, a guanine nucleotide exchange factor implicated in cytoskeletal dynamics, is poorly characterized in PCa. This study investigates DOCK3's role in PCa metastasis and tumor immune microenvironment (TIME) remodeling.

Methods: Multi-omics analyses integrated bulk RNA-seq from TCGA-PRAD (499 tumors/52 normals), scRNA-seq from GEO (45,325 cells), and genomic data. We performed: Differential expression analysis (DESeq2), Immune deconvolution (CIBERSORT,ssGSEA, xCell), WGCNA co-expression networks, Tumor mutational burden (TMB) assessment, Distant metastasis (M1 vs. M0) association studies, scRNA-seq clustering (Harmony/UMAP) and DE testing. Statistical significance thresholds: |log2FC|>1, padj<0.05.

Results: DOCK3 expression was found to be significantly elevated in metastatic (M1) tumors compared to primary (M0) tumors (p<0.05) and demonstrated a strong positive correlation with a higher tumor mutational burden (TMB) in metastatic samples (p<0.001). Cellular specificity analysis revealed that DOCK3 was exclusively and highly enriched within malignant epithelial and stromal cells, specifically in Cluster 6, where it exhibited a log2 fold-change of 9.13 (padj<1e-200) and was expressed in 54% of cells, compared to a negligible presence in all other clusters. In the tumor microenvironment, elevated DOCK3 expression was associated with a significant increase in cytotoxic immune infiltration, notably of CD8⁺ T and Natural Killer cells, a finding consistently supported by multiple computational algorithms (all p<0.05). Clinically, a high level of DOCK3 was significantly associated with metastatic status (p<0.01), whereas high expression of CDKN3 was correlated with advanced disease features, including higher Gleason scores (3-5) and T-stage (T2-T4) (p<0.01). Furthermore, significant differences in immune infiltration patterns were observed between clusters. Pathway enrichment analysis of genes co-expressed with DOCK3, identified through the WGCNA Green Module, indicated significant involvement in biological processes such as cytoskeletal reorganization, muscle contraction, and metabolic pathways (FDR<0.01).

Conclusion: DOCK3 drives PCa metastasis through cytoskeletal dynamics while paradoxically promoting an immunologically active microenvironment. Its tumor-specific expression and association with aggressive clinical features nominate DOCK3 as a novel biomarker for risk stratification and a promising therapeutic target for combinatorial immunotherapy in immunologically "cold" PCa.

Benign prostatic hyperplasia (BPH) is a common condition in aging men, leading to lower urinary tract symptoms (LUTS) that affect quality of life. Treatment options have evolved from invasive surgeries to a combination of pharmacological therapies, minimally invasive surgical therapies (MISTs), and standard surgical procedures. Medications such as α-blockers, 5-alpha reductase inhibitors (5-ARIs), and phosphodiesterase-5 inhibitors (PDE5i) are the first-line treatment for mild-to-moderate BPH, while MISTs like Rezūm, UroLift, Aquablation, and prostatic artery embolization (PAE) provide less invasive alternatives with shorter recovery times. For larger prostates, TURP and HoLEP remain the gold standards, offering effective long-term symptom relief despite some risks. Future advancements in BPH treatment focus on robotic-assisted surgery, AI-guided treatment selection, hybrid therapies, and regenerative medicine, aiming to enhance precision, reduce complications, and improve patient outcomes. This review summarizes current BPH management strategies and explores future innovations in the field.

Background: Erectile dysfunction (ED) is a frequent finding in men living with human immunodeficiency virus (HIV) (MLWH) and this remains a major concern because of its negative impact on the quality of life of those affected. There is limited data about the magnitude of ED and associated factors among MLWH in Tanzania. Thus this study was aimed to determine the prevalence of ED and associated factors among newly diagnosed antiretroviral therapy (ART)-naive MLWH in Mwanza, Northwestern Tanzania.

Methods: A cross-sectional study was conducted among 373 newly diagnosed ART-naïve MLWH attending voluntary counseling and testing centers of four selected hospitals in Mwanza region who were consecutively enrolled and subjected to thorough clinical and general physical examination, including anthropometric measurements. A pre-structured questionnaire was used to collect socio-demographic characteristics and clinical data. ED was assessed using the International Index of Erectile Function-5. Serum total testosterone, follicle-stimulating hormone, luteinizing hormone and estradiol were estimated. Data were entered in Microsoft Excel, cleaned and analyzed using STATA version 15.

Results: Of the 373 analyzed participants with a median age of 40 [IQR: 33-46] years, ED was found in 56.3% (95% CI 51.2%-61.3%), whereas the majority presented with mild (45.2%) to mild-moderate (40.0%) ED. The median testosterone was significantly lower in men with ED as compared with men without (294.5 [135-469] versus 482 [191-602] ng/ml; p<0.001). In a multivariate logistic regression analysis, ED showed significant association with World Health Organization (WHO) clinical stage 4 for HIV infection (AOR 3.2; 95% CI 1.1-9.2; p=0.032), low testosterone level (AOR 1.9; 95% CI 1.2-3.0; p=0.010), and being non-self-employed (AOR 3.7; 95% CI 2.0-7.0; p<0.001).

Conclusion: ED was found in more than half of ART naïve MLWH. The majority had a mild to mild-moderate ED. There was a significant association between ED and WHO clinical stage 4 for HIV infection, low testosterone level, and being non-self-employed. This finding emphasizes the need to routinely screen for early detection and management of ED in care and treatment center (CTC) clinics.

Background: Congenital hydronephrosis involves obstruction of the ureteropelvic junction, which impairs urine passage and elevates renal pelvic pressure. Elevated renal pelvic pressure detrimentally affects renal function. Pyeloplasty is a surgical procedure that aims to prevent deterioration of renal function. The Whitaker test, which is conducted using nephrostomy, is used to measure renal pelvic pressure. However, this method is highly invasive, highlighting the need for alternative testing approaches. Computational fluid dynamics (CFD) provides quantitative predictions of fluid flow phenomena and has recently been applied in medicine.

Objective: The aim of this study was to develop an evaluation method using computational fluid dynamics (CFD) to determine pyeloplasty indications.

Methods: The CFD were analyzed using computed-tomography-extracted images. The urine flow in the extracted geometry was simulated by solving the continuity and Navier-Stokes equations.

Key findings and limitations: CFD analysis revealed that renal pelvic pressure increases when urine output increases because of ureteropelvic junction obstruction during hydronephrosis. Furthermore, hydronephrosis with a renal pelvic pressure of 0.015-0.086 Pa, within the physiological urine output range of 360-1440 mL/day, was associated with poor renal function. The main limitation of this method is that the intrarenal pressure analyzed using CFD is an estimate and not the actual pressure.

Conclusions and clinical implications: Thus, renal-pelvic pressure can be measured through CFD analysis. Furthermore, CFD analysis can be used as a new modality to determine severity of obstruction.

Objectives: Patients with a poorly functioning kidney, defined as less than 20% differential renal function, have historically been considered poor candidates for ipsilateral ureteral reconstruction for stricture. To determine if renal function can be safely preserved in poorly functioning kidneys with ureteral stricture, we evaluated patient outcomes following ureteral reconstruction.

Methods: We conducted a review of 114 adult patients who underwent ureteral reconstructive surgery at our institution between 2013 and 2023. Patients with poorly functioning ipsilateral kidneys were identified by a preoperative renal scan (MAG3 renogram). Variables of interest included patient characteristics, peri/postoperative outcomes, resolution of hydronephrosis, pre/postoperative renal function, and preservation of renal parenchyma.

Results: Of the 8 patients meeting inclusion criteria, 5 underwent bladder elongation psoas hitch (BEPH), 1 ileal ureter, 1 ileal ureter with BEPH, and 1 ureteroureterostomy. Median preoperative differential renal function was 16.0% with a median preoperative serum creatinine (sCr) of 1.70 mg/dL before decompression and 1.35mg/dL after percutaneous nephrostomy tube (PCN) placement. Preoperative median average renal parenchyma thickness (RPT) was 14.5mm. At 6-month follow-up, median sCr and RPT were preserved at 1.25mg/dL (p= 0.084) and 14.3 mm (p=0.41), respectively. At median follow-up of 49.2 months, all patients had a successful repair, defined as no reinsertion of stent/PCN, resolution of hydronephrosis, and no return to the operating room for revision or nephrectomy. Median sCr at last follow-up showed sustained improvement at 1.22 (p=0.0097).

Conclusions: Reconstruction can be successful for obstructed kidneys with less than 20% differential function and may be considered prior to nephrectomy.

Objective: To analyze the related literature of self-reported outcomes of prostate cancer patients using bibliometric methods, and explore the research status and development trend in this field.

Methods: The literature related to self-reported outcomes of prostate cancer was searched in Web of Science core database. The literature on prostate cancer self-reported outcomes was visualized using VOSviewer, CiteSpace and R software packages.

Results: A total of 1119 relevant literatures were retrieved. Annual output consistently exceeded 100 articles since 2018, peaking at 161 in 2022. The U.S. (47.2%) and U.K. (21.5%) contributed 68.7% of publications. The University of Michigan emerged as the most productive institution. Collaborative networks showed strong U.S.-European ties, while Asian engagement intensified post-2020.The journal International Journal of Radiation Oncology Biology Physics (n=69) published most papers, whereas Journal of Clinical Oncology (n=48, citations=1,412) was most influential. Dual-map analysis revealed frequent citations from molecular/biology journals to clinical medicine literature. Barocas D.A., Cooperberg M.R., Koyama T., and Chen R.C. (21 publications each) were top producers. Ethan Basch (259 co-citations) was the most cited scholar. The EPIC scale development study (Wei et al., 2000) was the most co-cited reference. Key citation bursts included Taneja's long-term outcomes study (2013-2018) and the CHHiP radiotherapy trial (2018-2021). "Quality of life" (181 occurrences) dominated keyword analysis, followed by "radiation therapy" and "prostatectomy." Five thematic clusters emerged: radiotherapy with a blue cluster, prostatectomy with a green cluster, daily management with a red cluster, research methods with a yellow cluster and scale development with a purple cluster. Qualitative methods gained prominence after 2020, while exercise and radiotherapy remained sustained intervention focuses.

Conclusions: The reported outcomes of patients with prostate cancer have continued to receive attention in the past 10 years. In this study, three recognized bibliometric software were used for the first time to analyze the related studies on the reported outcomes of patients with prostate cancer, so as to provide reference and direction for future research.