American journal of clinical and experimental urology最新文献

Objective: Metabolites of volatile organic compounds (mVOCs) have attracted considerable attention in contemporary research. The urine flow rate (UFR) serves as an objective metric for a full evaluation of bladder function. This research aimed to investigate the correlation between mVOCs and UFR.

Methods: We examined mVOCs and UFR data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2020. The mVOCs measurements were subjected to log transformation to achieve normal distribution. We used weighted multivariate linear regression models to evaluate the association between mVOCs andUFR. The relationship between mVOCs mixture and UFR was assessed using three different analytical models: Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS), and quantile g-computation (Qgcomp). An analysis stratified by gender was also conducted.

Results: The research had 3,370 participants, of whom 1,703 (51%) were male. Multivariate linear regression revealed a negative correlation between increased mVOCs and UFR across all research cohorts (all P < 0.001). The BKMR model displayed a notable negative correlation, identifying N-Acetyl-S-(3,4-dihydroxybutyl)-L-cysteine (DHBMA) and Phenylglyoxylic acid (PGA) as possibly important chemicals. The WQS model exhibited a negative connection with UFR across the total cohort and its male and female subgroups, with all P values being less than 0.05. The findings of the Qgcomp model aligned with those of the WQS model.

Conclusions: Our data indicate a substantial negative connection between exposure to urinary mVOCs and UFR among US adults, with no notable gender differences seen.

Lower urinary tract dysfunction (LUTD) is prevalent in aging men. It is characterized by urinary symptoms such as weak stream and more frequent urination, and is linked to a variety of prostate and urethral pathologies. While the leading medical therapies for male LUTD aim to reduce the tone and volume of the prostate and urethra, no current therapies target two prominent emerging mechanisms of male LUTD: prostate inflammation and fibrosis. LUTD arises and progresses over decades of a man's life, making it difficult to pinpoint disease mechanisms. Non-human research models, including mice, have been useful for investigating slow-progressing diseases of aging. Research involving mouse models of lower urinary tract dysfunction is surging due to a growing suite of genetic, pharmacological and immune-based tools for manipulating mouse prostate histopathology, cell signaling and phenotyping mouse urinary voiding. Current research is focused on understanding how macrophages, fibrocytes, mast cells and other cells are recruited to the prostate and how these cells are activated to drive prostate inflammation and fibrosis. This review highlights recent mouse studies to investigate the cellular and molecular underpinnings of prostate inflammation and fibrosis, and the molecular mechanisms that have emerged from these studies as potential therapeutic targets.

Renal aging contributes to declining kidney function and heightened susceptibility to chronic kidney disease (CKD). A key factor in this process is the diminished number and functionality of renal stem/progenitor cells, though the underlying mechanisms remain incompletely understood. Human urine-derived stem/progenitor cells (USCs) represent a promising, non-invasive source with notable regenerative potential. In this study, we examined cellular proliferation, reactive oxygen species (ROS) production, and senescence-associated protein expression as indicators of age-related degeneration in renal progenitor cells. USCs obtained from older healthy and diabetic individuals were compared to those from young, healthy donors. Our results demonstrate that USCs from aged and diabetic donors exhibit significantly reduced proliferation, elevated ROS levels, and increased β-galactosidase expression. Moreover, these cells showed impaired capacity to form 3D renal spheroids with tubular-like structures over a two-week culture period, relative to young controls. Together, these findings suggest that USCs from older or diabetic individuals - when cultured in both 2D and 3D systems - serve as a valuable model for studying renal aging and progenitor cell dysfunction. This model may facilitate the identification of biomarkers for renal aging and CKD risk and inform future regenerative and therapeutic strategies.

Clear Cell Urothelial Carcinoma (CCUC) is a rarely reported urothelial carcinoma variant first described in 1995. Due to CCUC's clinical rarity, reporting additional cases may aid future clinicians on surgical and oncological management. We present a case of an 89-year-old male with primary CCUC and highlight the aberrant histopathological findings with a literature review. This study aims to add to current descriptions of CCUC and inform surgical and oncological management in future patients. An 89-year-old male with a history of smoking presented to clinic with painless hematuria of six months duration. Imaging showed right-sided hydroureteronephrosis down to a bladder mass. This was confirmed to be a bladder tumor on office cystourethroscopy. Following TURBT procedure, the pathology report came back suggesting 3.6 cm superficial low-grade Ta CCUC. Five months later, the patient presented with hematuria, acute kidney injury, and anemia. He was found to have T3a muscle-invasive urothelial carcinoma. This was confirmed on additional analysis which showed an FGFR3 mutation and abundant glycogen-filled clear cells. Histologically, CCUC is characterized by a glycogen-rich clear cytoplasm, severe atypia and a "nested" growth pattern. CCUC may be differentiated from non-CCUC by as few as a 30% clear cell change morphology of all cells. CCUC must be differentiated from Renal Cell Carcinoma and Clear Cell Adenocarcinoma. Treatment for CCUC has varied by case, with some surgeons electing to treat with radical cystectomy while others opting for local resection. Our case helps combat the paucity of literature by further characterizing and contributing to the management of CCUC.

Recently, accumulating studies demonstrate that some long non-coding RNAs (lncRNAs) contain open read frames and have protein/peptide-coding potential. NCYM is a 109-amino acid product encoded by lncRNA MYCNOS variant 2 that is an antisense transcript of MYCN oncogene. NCYM is amplified in human neuroblastomas and associated with poor prognosis. However, its functional role in Wilms tumor (WT) remains unclear. In this study, we identified lncRNA MYCNOS as a promising prognostic factor in Wilms tumor through bioinformatics analysis. The expression of NCYM and downstream genes was determined by western blotting. Cell proliferation, migration, and invasion were measured by CCK-8, wound healing and Transwell assays, respectively. Cell apoptosis was evaluated by flow cytometry assay. The subcutaneous xenograft and lung metastasis mouse model were established by the armpit injection or tail intravenous injection of WT cells, respectively. Our results showed that NCYM was validated to be abundantly expressed in Wilms tumor cell lines and tissues. The exogenous overexpression of NCYM promoted WT cell proliferation, migration, and invasion. The silencing of SIX1 expression abolished the pro-growth effect of NCYM and downregulated β-catenin in WT. Additionally, NCYM facilitated tumor growth and formation of lung metastasis in vivo. In summary, the exogenous overexpression of NCYM could play a critical role in WT progression by mediating SIX1 and β-catenin as an oncopromoting factor.

Artificial Intelligence (AI) is revolutionizing prostate cancer (PCa) care, addressing the major clinical challenges of subjectivity and overtreatment. Our traditional tools - like PSA, DRE, mpMRI, and Gleason scoring - often lack the precision needed to distinguish truly aggressive tumors from indolent disease, leading to unnecessary morbidity in up to 50% of low-risk men. This review explains how AI, specifically machine learning (ML) and deep learning (DL), is poised to solve this. We cover AI's role from initial diagnosis, where radiomics and digital pathology boost grading accuracy and reduce inter-reader variability, to treatment selection and surgical precision through predictive models and Augmented Reality (AR) guidance. We also detail its utility in predicting biochemical recurrence (BCR) and managing long-term side effects. Finally, we address the critical barriers to adoption, including the need for large, diverse datasets (to combat algorithmic bias), the "black box" problem (solved by Explainable AI, XAI), and navigating FDA regulation. The future of PCa care hinges on this precise, data-driven approach.

Objectives: Clear cell and papillary renal cell carcinomas (RCC) are the two most common RCC subtypes, accounting for approximately 70% and 15% of kidney cancers, respectively. Clear cell RCC is commonly associated with VHL alterations, while papillary RCC typically exhibits chromosomal abnormalities such as +7, +17, and -Y. Furthermore, clear cell RCCs are less likely to exhibit PBRM1 and SETD2 alterations. This study aims to improve the accuracy of RCC diagnosis by investigating molecular alterations in RCC cases with clear cells, papillary structures, and other atypical histological features.

Methods: Nine RCC cases were retrospectively selected and analyzed using histologic slides and immunohistochemical staining for CAIX, RCC, CD10, CK7, P504S, Vimentin, and EMA. Next-generation sequencing was performed on all cases to identify genetic mutations, and cytogenetic analysis was conducted on one case.

Results: The cohort consisted of nine male patients aged 49 to 68 years (mean 61.4). Surgical specimens included six radical and three partial nephrectomies; seven tumors were located in the left kidney and two in the right. Tumor sizes ranged from 0.8 to 15.2 cm. Immunohistochemical analysis revealed positive staining for RCC (6/9), CAIX (3/4), CD10 (6/6), and CK7 (5/9). In six clear cell RCCs, next-generation sequencing identified VHL mutations in four tumors, PBRM1 alterations in three, and SETD2 mutations in one. Five tumors with papillary fronds, sarcomatous components, or unclassified features harboring VHL, PBRM1, and/or SETD2 mutations were reclassified as clear cell RCC. One clear cell RCC with leiomyomatous stroma showed mTOR mutations. A case of clear cell papillary renal cell neoplasm showed no reportable gene mutations. The role of a FANCA mutation in one papillary RCC remains uncertain. Cytogenetic analysis of one case (Case #5) revealed 50, X, -Y, +3, +7, +16, +17, +20, consistent with papillary RCC.

Conclusions: Next-generation sequencing is a useful method for categorizing RCCs with clear cells, papillary features, and unusual histology. Additionally, VHL mutations could be a promising target for personalized treatment in clear cell RCCs and their histologic variants.

Objectives: This study evaluated the cancer detection profile of magnetic resonance imaging/transrectal ultrasound fusion-guided biopsies (fusion biopsy) using the BiopSee^® system in patients assessed with the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1, focusing on clinically significant prostate cancer (csPCa) detection in regions of interest (ROI) and non-ROI areas.

Methods: We retrospectively analyzed 59 patients who underwent fusion biopsy between February and November 2024. Detection rates of csPCa (grade group ≥ 2) were compared between the ROI and non-ROI regions, and clinical and biopsy characteristics were compared between patients with and without csPCa. Univariate logistic regression analysis was performed to identify predictors of csPCa.

Results: The median patient age was 74 years, with a median prostate-specific antigen (PSA) level of 8.93 ng/mL. The csPCa detection rate was significantly higher in the ROI than in the non-ROI regions (61% vs. 44%, P = 0.012). Across the cohort, PI-RADS 4 and 5 lesions were more common than PI-RADS 3 lesions. A higher PI-RADS score (4 or 5) was identified as a significant predictor of csPCa detection (odds ratio 5.14, P = 0.034), whereas age, PSA, number of ROIs, and biopsy core numbers were not significant predictors.

Conclusions: Fusion biopsy using the BiopSee^® system achieved a high csPCa detection rate in targeted ROIs, especially for PI-RADS 4 and 5 lesions, while also highlighting the importance of combining systematic biopsy with targeted approaches because of the substantial proportion of csPCa detected in non-ROI regions.

Objectives: To compare prostate cancer rates in magnetic resonance imaging (MRI)-detected lesions for patients who are chronically taking beta-blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), or immunosuppressors.

Methods: This cohort consisted of 897 Prostate Imaging Reporting & Data System (PI-RADS)v2 3-5 lesions from 590 MRI-targeted fusion prostate biopsies (UroNav). Baseline characteristics and clinicopathological data were collected. A matching cohort was analyzed, and multivariate analysis was completed for each medication group. Matching analysis accounted for age, prostate-specific antigen (PSA), and PI-RADS score. Multivariate analysis additionally considered lesion size.

Results: Of the 897 lesions, 261/897 (29%) of lesions were identified as PI-RADS 3, 373/897 (42%) were PI-RADS 4, and 263/897 (29%) were PI-RADS 5. In the patient cohort, 16% were taking a beta-blocker, 3.9% were taking an NSAID, and 5.4% were taking an immunosuppressant. An equal number of lesions in controls were matched to 148 lesions in males taking beta-blockers, 37 lesions in males taking NSAIDs, and 46 lesions in males taking immunosuppressants. Matching was based on age, PSA, and PI-RADS score. In the matched cohort, neither beta-blockers, NSAIDs, nor immunosuppressants altered clinically significant prostate cancer (csPCa) identification on MRI (OR 1.11, CI 95% 0.6, 1.9; OR 0.70, CI 95% 0.32, 1.66; OR 1.73, CI 95% 0.59, 5.35, respectively).

Conclusion: This pilot study shows no difference in csPCa detection rates in patients using anti-inflammatories or drugs that alter prostate blood flow.

Objective: To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with a flexible vacuum-assisted ureteral access sheath (FV-UAS) in patients with 1-2 cm lower calyceal renal stones.

Patients and methods: In total, 203 patients with calyceal stones were prospectively randomized into two groups (Clinical trial registration number: ChiCTR2200056402). Of them, 101 patients were assigned to the FV-UAS group and 102 to the traditional UAS group (control). The primary outcome was the stone-free rate (SFR) on postoperative day 1 and in the 4th week. Secondary outcomes included operative time, length of postoperative hospital stay, hospitalization costs, and procedure-related complications.

Results: No significant differences were noted in baseline demographics and preoperative clinical characteristics between the two groups (all P > 0.05). Postoperative data indicated that the SFRs on both postoperative day 1 and week 4 were significantly higher in the FV-UAS group than in the traditional UAS group (86.1% vs. 70.6%, P = 0.007; 92.1% vs. 82.4%, P = 0.038, respectively). Hospitalization costs were also lower in the FV-UAS group than in the traditional UAS group ($2524.1 vs. $2635.4, P < 0.001). Furthermore, the incidence rates of postoperative fever, perirenal hematoma, and urosepsis were significantly lower in the FV-UAS group than in the traditional UAS group (fever: 2.0% vs. 8.8%, P = 0.031; hematoma: 0.0% vs. 4.9%, P = 0.024; urosepsis: 1.0% vs. 7.8%, P = 0.018).

Conclusions: Our findings suggest that the combination of FV-UAS and RIRS offers a promising treatment approach for 1-2 cm lower calyceal renal stones. This method results in higher SFRs, lower complication rates, and reduced hospitalization costs, making it a valuable technique for clinical adoption.