BMC Urology最新文献

Purpose: To present the initial experience and clinical outcomes of ileal ureteric replacement (IUR) for complex ureteral stricture after treatment failure of Allium stents.

Methods: From June 2020 to July 2022, a total of eight patients underwent IUR for complex ureteral strictures after treatment failure of Allium stents across three tertiary centers. Surgical approaches included open (n = 3), laparoscopic (n = 2), and robot-assisted (n = 3). The clinical data and follow-up results were prospectively collected.

Results: A total of eight patients were enrolled, including seven women and one man, with a mean age of 47.8 years. The median dwelling time of Allium stents was 12.5 months. Reasons for Allium stent failure included recurrent urinary tract infection (UTI), stent migration, unrelieved hydronephrosis and stent calculus. The median stricture length was 15 cm. Four patients underwent unilateral IUR and four underwent bilateral IUR, with a median harvested ileal segment length of 25 cm. The median operation time was 261 min and the median estimated blood loss was 75mL. During a median follow-up of 24 months, ureteral patency was achieved in all patients. The mean eGFR was 71.2 ± 34.5 preoperatively and 65.9 ± 23.9 mL/min/1.73m² at the last follow-up (p = 0.394). Two patients in the open surgery group experienced major complications, specifically ileus and incisional hernia. Long-term minor complications included UTI (n = 5) and metabolic acidosis (n = 2).

Conclusion: Allium stents should be applied with caution and strict indications. For patients experiencing stent failure, IUR serves as a viable salvage option for managing long and complex ureteral strictures.

Objective: To explore the potential mechanisms of interstitial cystitis (IC), we employed a cyclophosphamide (CYP)-induced cystitis rat model, a well-established tool for studying IC-like bladder inflammation and dysfunction. This study aimed to investigate the role of rhythmic genes and immune microenvironment remodeling in this model, focusing on TOP2A and its impact on T-cell infiltration.

Methods: CYP-induced cystitis rat models were established using cyclophosphamide. Single-cell RNA sequencing was performed on bladder tissues to analyze cellular heterogeneity. Differentially expressed genes (DEGs) and weighted gene co-expression network analysis (WGCNA) identified rhythmic and immune-related gene clusters. TOP2A was validated via RT-PCR, Western blot, and immunohistochemistry (IHC). Statistical analyses assessed correlations between TOP2A, CD4 + T cells, and CD8 + T cells.

Results: Single-cell sequencing revealed elevated T-cell infiltration in a CYP-induced cystitis rat model. TOP2A was the sole overlapping gene between rhythmic and immune clusters and showed significant upregulation in IC tissues (P < 0.05). IHC confirmed increased TOP2A, CD4 + T, and CD8 + T cell levels, with strong positive correlations (r = 0.89 and 0.64, respectively). Functional enrichment linked TOP2A to oxidative phosphorylation and ribosomal pathways.

Conclusions: Our findings demonstrate that TOP2A drives immune dysregulation in CYP-induced cystitis by modulating T-cell infiltration. As T-cell infiltration is a hallmark of human IC, our findings in this CYP-induced model suggest that TOP2A may represent a novel therapeutic target worthy of further investigation in human IC tissues.

Background: New evidence shows that gut microbiota dysbiosis may play a crucial role in the development process of benign prostatic hyperplasia (BPH). However, at present, the specific characteristics of the gut microbiota in patients with BPH have not been fully clarified.

Methods: The PubMed, MEDLINE and Web of Science databases were systematically searched to find the clinical and preclinical studies related to the relationship between BPH and gut microbiota from the establishment of the databases to October 7, 2025. And the studies reporting on gut microbiota and BPH were analyzed.

Results: A total of 10 preclinical studies and 6 clinical studies were included. These studies covered 413 patients with BPH, 338 controls, and 5 different types of BPH mouse models in total. Compared with the control group, there were significant differences in β-diversity in the BPH group. A significant increase in the Firmicutes/Bacteroidetes (F/B) ratio was regarded as a marker of the pathological condition. Specifically, changes in the abundances of Prevotella, Ruminococcus, and Lactobacillus may play a key role in the pathogenesis of the occurrence and development of BPH. The imbalance of interleukin-6 (IL-6) and interleukin-18 (IL-18), as well as changes in the levels of intestinal tight junction protein-1 and claudin-1, may also be related to the pathogenesis of BPH.

Conclusions: Changes in the abundances of specific gut microbiota and their metabolites, such as an increased F/B ratio and a decreased abundance of Lactobacillus, as well as the levels of inflammatory indicators and markers of intestinal barrier dysfunction, may play a crucial role in the pathogenesis of BPH. These factors may become effective diagnostic means and potential therapeutic targets for BPH.

Background: Obesity significantly increases the risk of developing urinary tract stones, particularly distal ureteral stones, which can complicate treatment with extracorporeal shockwave lithotripsy (SWL). In obese patients, the distance between the skin and the stone often exceeds the effective shockwave range, reducing SWL efficacy. This study presents an innovative SWL assistive device designed to address this challenge by using natural body passages such as the rectum or vagina to shorten the distance between the skin and the stone.

Methods: Three obese patients with distal ureteral stones who were initially unsuitable for conventional SWL due to excessive skin-to-stone distance were included. An assistive device was used via natural body passages to reduce the skin-to-stone distance during SWL. Clinical outcomes were assessed by postoperative imaging. Descriptive analysis was performed.

Result: In three obese patients with distal ureteral stones, the use of the device allowed SWL to be performed effectively, with no residual stones detected on follow-up imaging. The device has been patented in China (Patent No.: ZL 2020 2 2018950.0) and is undergoing larger-scale clinical trials to further evaluate its safety and efficacy.

Conclusions: This development offers a promising solution for obese patients who were previously unable to undergo effective SWL treatment.

Trial registration: Not applicable.

Background: The present study compared the clinical outcomes and indications of metallic ureteral stents (MS) and polymeric ureteral stents (PS) in patients with malignant ureteral obstruction (MUO).

Methods: We analyzed 148 patients (240 ureters) with MUO who underwent ureteral stent placement at our Department of Urology between December 2014 and April 2022. The cohort included 67 patients (112 ureters) who received metallic stents (MS group) and 81 patients (128 ureters) who received polymeric stents (PS group). We evaluated overall survival and the primary underlying malignancies, and compared operative times, ureteral stent patency rates, and factors associated with stent obstruction between the two groups.

Results: The one-year overall survival rate of patients with MUO was 27.2%, with a median survival time of 209 days. The main primary malignancies were gynecologic and gastrointestinal cancers, most commonly cervical, gastric, colorectal, breast, and ovarian cancers, in that order. The operative time for stent insertion was significantly longer in the MS group than in the PS group for both bilateral (p = 0.0004) and unilateral (p = 0.0094) placements. The one-year stent patency rate was significantly higher in the MS group (62.0%) than in the PS group (48.5%) (p = 0.0144). Factors associated with stent obstruction included lower ureteral obstruction (p = 0.0401), direct tumor compression (p = 0.0172), pyuria (p = 0.0028), and elevated preoperative serum creatinine (p = 0.0088) in the MS group, and peritoneal dissemination (p = 0.0005) in the PS group. A comparison of stent patency between the groups according to obstruction factors showed no significant differences for lower ureteral obstruction (p = 0.5140), direct tumor compression (p = 0.8215), or pyuria (p = 0.8401). However, among patients with peritoneal dissemination, the stent patency period was significantly longer in the MS group (p = 0.0001).

Conclusions: Metallic ureteral stenting, which has higher patency rates than PS, is a safe and effective treatment option for MUO, particularly in the patients with peritoneal dissemination.

Background: Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hyperplasia (BPH), but its efficacy decreases in large prostates. Bipolar enucleation of the prostate (BipolEP) has been introduced as a modification enabling complete adenoma removal and potentially superior outcomes. This study compared the efficacy and safety of bipolar TURP (B-TURP) and BipolEP in patients with large prostate volumes (≥ 80 mL).

Patients and methods: Seventy patients with prostate volume ≥ 80 mL and bladder outlet obstruction were prospectively randomized to undergo either B-TURP (n = 37) or BipolEP (n = 33). Both procedures were performed using standardized bipolar platforms. Postoperative management followed uniform bladder irrigation and catheterization protocols. Primary outcomes were functional parameters (IPSS, Qmax, PVR), while secondary outcomes included perioperative parameters and complications. ANCOVA analysis adjusting for baseline IPSS and Qmax, and Post-hoc power analysis were performed.

Results: Both groups showed significant postoperative improvement in IPSS, Qmax, and PVR (p < 0.001). Compared with B-TURP, BipolEP achieved a greater reduction in IPSS (p = 0.04) and higher postoperative Qmax (p = 0.004). Operative time, irrigation volume, catheterization duration, and residual tissue were all significantly lower in the BipolEP group (p < 0.05). Retrograde ejaculation occurred more frequently after BipolEP (81.8% vs. 48.6%, p = 0.004), whereas other complications were comparable. ANCOVA confirmed that between-group differences in IPSS and Qmax remained significant after adjusting for baseline values.

Conclusion: In patients with large prostates, BipolEP offers superior functional outcomes and improved perioperative efficiency compared with B-TURP, though at a higher risk of retrograde ejaculation. These findings support BipolEP as a preferred surgical option for large-volume BPH.

Trial registration: The study is registered in clinical trials (ClinicalTrials gov ID: NCT05330156 ; Registered on April 15, 2022).