Teaching postoperative follow-up for renal cell carcinoma (RCC) is challenging during brief urology rotations. We evaluated a structured module based on a simplified risk model (IMDB: venous invasion, tumor size ≥ 7 cm, systemic symptoms, renal sinus fat invasion) to improve residents' knowledge and clinical decision-making. Forty residents who completed the 8-10 h module (2022-2025) were enrolled in this retrospective pre-post study. The module used a Postoperative Health Management Passport integrating lectures, simulations, outpatient practice, and debriefing. Knowledge was assessed by validated questionnaire (pre/post). Decision-making was scored on follow-up card assignments (0-15). Satisfaction was measured by 5-point Likert scale. Knowledge scores increased from 65.75 ± 5.13 to 90.88 ± 4.92 (mean gain 25.13 ± 4.00; t = 39.71, P < 0.0001). Decision-making scores: IMDB accuracy 4.52 ± 0.64, plan rationality 4.19 ± 0.65, patient education 3.93 ± 0.81. Inter-rater reliability was excellent (ICC = 0.97), pass rate 92.5% (37/40). Satisfaction was 96.1%; 100% would recommend the module. Knowledge gain did not correlate with decision-making scores (all r ≤ 0.07, P > 0.05). Second-year residents improved most (27.00 ± 4.14 points, F = 4.307, P = 0.0208). The IMDB-based module effectively enhanced residents' knowledge and decision-making. However, because the decision-making assessment showed near-ceiling performance, the absence of a significant correlation between knowledge gain and decision-making scores should be interpreted with caution; a more sensitive assessment instrument is needed to meaningfully examine this relationship in future studies. The "learn-practice-reflect" framework offers a reproducible model for integrating clinical tools into residency training.
To create a pathway-based, vertically integrated teaching program on hematuria management that encourages competency development, and to analyze its effect in competency transfer among urology clerkship students. Eighty clerkship students were recruited (intervention group, n = 40; control group, n = 40) in a single-center, quasi-experimental controlled study. Data on weekly tests, case presentation score, end-of-rotation comprehensive score, and a modified OSCE were collected. Between-group comparisons were performed using Welch-corrected independent-samples t tests for continuous outcomes, Fisher's exact test or χ² test for categorical baseline variables, and covariate-adjusted linear regression with HC3 robust standard errors for the OSCE total score. The two groups had similar age, sex, and major composition. The intervention group obtained a relatively higher formative assessment performance with a higher mean weekly test score than the control group (94.09 ± 2.58 vs. 86.50 ± 8.10, P < 0.001), and a slightly higher case score (7.39 ± 0.60 vs. 7.14 ± 0.46, P = 0.045), while the end-of-rotation comprehensive score did not meet the significance level (P = 0.771). The simulation-based OSCE showed a significantly higher OSCE total score in the intervention group (85.39 ± 4.02 vs. 80.00 ± 5.16, P < 0.001), with main differences in domains related to management and communication; the group effect remained significant after covariate adjustment (beta = 5.56, P < 0.001). The hematuria-focused, vertically integrated teaching program was associated with improved formative assessment performance and case presentation quality, and with better performance in a simulation-based modified OSCE assessing competency transfer. Future larger-scale randomized controlled studies are needed to further validate these findings.
Urology presents unique challenges for AI systems, requiring both extensive medical knowledge and advanced reasoning. While large language models (LLMs) like GPT-4 have shown promise in medical education and decision support, their performance in urology remains underexplored. To provide a time-stamped comparison of two representative large language models available at the time of evaluation, ChatGPT-4o and DeepSeek R1, in answering urology-related single-choice questions, and to evaluate their accuracy, stability, and response consistency across different response configurations. A total of 809 single-choice questions from the Chinese National Qualification Examination for Attending Physicians in Urology were administered to ChatGPT-4o and DeepSeek R1. Each model was tested under three configurations: basic mode, deep-thinking mode, and web-enabled retrieval. Accuracy was calculated for each configuration, and statistical comparisons were performed using McNemar's test. Stability across reasoning modes was assessed by comparing performance variability. Additional analyses examined performance differences between short-answer and case-based clinical questions. ChatGPT-4o achieved accuracy rates of 78.12%, 73.79%, and 78.99% in basic, deep-thinking, and web-enabled retrieval modes, respectively. DeepSeek R1 outperformed ChatGPT-4o across all configurations, with accuracy rates of 83.19%, 81.46%, and 84.55%, respectively. All between-model differences were statistically significant (p < 0.001). DeepSeek R1 demonstrated greater internal stability across reasoning modes, whereas ChatGPT-4o showed notable variability. In subgroup analyses, DeepSeek R1 exhibited a more pronounced advantage in complex, case-based clinical questions. Both models performed consistently across urological disease categories, and findings were limited to the Chinese-language context in which the evaluation was conducted. DeepSeek R1 showed superior performance compared with ChatGPT-4o in both accuracy and stability when answering urology-related examination questions, particularly in complex case-based scenarios. These results suggest that optimized LLMs may have potential utility in urology education and examination-style question answering, especially within Chinese-language environments. However, these findings should not be interpreted as evidence of readiness for real-world clinical decision support, and further validation in clinically realistic settings is required.
The comparative efficacy and safety of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) have been extensively evaluated in the general adult population; however, evidence specifically focused on older patients remains limited. Given the underrepresentation of older individuals in comparative studies and the lack of age-specific meta-analytic data, we conducted a systematic review and meta-analysis to evaluate and compare the efficacy and safety of RIRS versus PCNL in the geriatric population. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comparative studies evaluating outcomes of RIRS and PCNL in older patients were identified through comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library up to January 2026. Primary outcomes included overall, minor, and major complications, as well as stone-free rate (SFR). Subgroup analyses were performed according to the age thresholds used to define the geriatric population (≥ 60 and ≥ 65 years). Eight studies including 849 older patients (419 RIRS, 430 PCNL) were analysed. PCNL was associated with a significantly higher final SFR (OR 0.63, 95% CI: 0.43-0.93; p = 0.02). RIRS was associated with lower odds of overall complications (OR 0.54, 95% CI: 0.37-0.80; p = 0.002), minor complications (OR 0.65, 95% CI: 0.43-0.98; p = 0.04), major complications (OR 0.30, 95% CI: 0.12-0.74; p = 0.008), and blood transfusion (OR 0.14, 95% CI: 0.04-0.49; p = 0.002). No significant differences were observed in postoperative fever or sepsis. Operative time did not differ significantly, whereas hospital stay was significantly shorter following RIRS (MD - 2.0 days, 95% CI: -2.6 to - 1.3; p < 0.001). In older adults, PCNL was associated with higher stone clearance rates, whereas RIRS showed a more favourable safety profile and shorter hospitalisation. Treatment selection should balance efficacy against perioperative morbidity.
Large language models (LLMs) are increasingly explored as tools for medical education. However, evidence remains limited regarding their pedagogical quality and real-world utility in prostate cancer teaching within urology residency training. We conducted a two-phase study. Phase 1 benchmarked three LLMs (ChatGPT-4o, DeepSeek R1, and Gemini 2.0) on a structured 40-item prostate cancer education question bank using standardized prompts and blinded expert ratings. Phase 2 implemented the top-performing model in a pilot randomized teaching trial among urology residents (n = 34) using stratified block randomization based on a pre-admission standardized test score, with allocation concealment implemented through a centralized web-based system. Both groups received identical offline instruction with a time-matched lecture structure. The control group committed to avoiding LLM use for course-related questions during the teaching period. DeepSeek R1 ranked highest in expert ratings, with clearer advantages on higher-order and innovation-oriented questions. In the pilot randomized teaching trial (n = 34), the AI-assisted group achieved higher closed-book examination scores than controls (68.47 ± 12.78 vs. 57.91 ± 10.47; MD 10.56, 95% CI 2.39-18.73; p = 0.013). Improvements were most evident in Multiple-Choice Questions(MCQs) (MD 9.27, 95% CI 4.37-14.17; p < 0.001) and research items (MD 3.32, 95% CI 1.72-4.92; p < 0.001), whereas Multidisciplinary Team(MDT) case analysis showed no clear difference. Student and instructor feedback was generally positive. LLM-assisted teaching was associated with higher knowledge-based examination performance, especially for MCQ-style and innovation-focused content, while effects on MDT reasoning remain uncertain. These preliminary findings suggest that carefully guided LLM use may support residency teaching, but larger multicenter studies and structured verification workflows are needed to confirm effectiveness and generalizability.
The European Association of Urology 2024-2025 guidelines recommend conservative management as first-line therapy for pediatric phimosis before considering surgical intervention. Balloon catheter dilation treatment (BCDT) has emerged as a promising foreskin-preserving approach, yet high-quality comparative evidence against conventional circumcision (CC) remains limited. This study aimed to compare the clinical efficacy, safety outcomes, and family-centered measures between BCDT and CC in a pediatric cohort. This retrospective cohort study enrolled 200 boys (aged 2-12 years) with Kikiros grade ≥ 2 phimosis treated between January and December 2024 at a tertiary pediatric surgery center. Patients were allocated to BCDT (n = 100) or CC (n = 100) groups based on treatment received. Primary outcomes included cure rates (Kikiros grade 0-1) at 6 months. Secondary outcomes encompassed procedure-related parameters, complication rates, pain assessment using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, healing time, parent-reported satisfaction, and health literacy-associated compliance measures. Propensity score analysis confirmed baseline comparability. Number needed to treat (NNT) and effect sizes (Cohen's d) were calculated to quantify clinical significance. Both treatments achieved high 6-month cure rates (BCDT: 98.0% vs. CC: 100.0%; P = 0.497; absolute risk difference: 2.0%, 95% CI: -0.7% to 4.7%). BCDT demonstrated substantial advantages in procedure efficiency (mean operative time: 5.03 ± 0.62 vs. 29.38 ± 6.69 min; P < 0.001; Cohen's d=-5.13) and recovery parameters (healing time: 6.74 ± 2.13 vs. 15.90 ± 3.06 days; P < 0.001; Cohen's d=-3.47). Pain-related outcomes significantly favored BCDT: lower incidence (65.0% vs. 99.0%; P < 0.001; NNT = 3), shorter duration (21.2 ± 14.0 vs. 93.2 ± 55.6 h; P < 0.001), and reduced FLACC scores at 24 h (2.59 ± 1.44 vs. 5.22 ± 2.07; P < 0.001; Cohen's d=-1.48). Edema occurrence was substantially lower in the BCDT group (60.0% vs. 100.0%; P < 0.001; NNT = 2.5). Parent satisfaction rates (score 5, very satisfied) were 96.0% and 88.0% for BCDT and CC, respectively (P = 0.068). Parent health literacy (Newest Vital Sign score) positively correlated with home care compliance (r = 0.42; P < 0.001), with adequate literacy (NVS ≥ 4) associated with significantly better adherence (3.21 ± 0.58 vs. 2.74 ± 0.71; P < 0.001). In this retrospective cohort, BCDT achieved short-term (6-month) cure rates non-inferior to CC while offering clinically meaningful advantages in procedural simplicity (6-fold reduction in operative time), pain mitigation (34% absolute reduction in incidence), accelerated healing (2.4-fold faster), and enhanced parent satisfaction. As a foreskin-preserving, minimally invasive option requiring only topical anaesthesia, BCDT may be considered for carefully selected symptomatic children with pathological phimosis, within a stepwise conservative management strategy that includes watchful waiting and topical corticosteroids as first-line therapy. Routine intervention for asymptomatic physiological phimosis is not supported by these data, and durable cure, long-term recurrence prevention, and broad first-line adoption require confirmation in prospectively designed studies with follow-up extending beyond puberty. Outcomes are optimised when supported by adequate parent health literacy for post-procedure home-care adherence.
The introduction of robotic-assisted abdominal surgery is aimed at reducing the primary and secondary adverse outcomes. Anesthesia in robotic surgery varies from anesthesia for open or laparoscopic surgical procedures. The choice of anesthesia influences the perioperative control of pain, nausea, vomiting, and Optic nerve sheath diameter (ONSD). The purpose of this systematic review was to assess outcome variation in patients undergoing transabdominal robot-assisted surgery done under total intravenous anesthesia or inhalational anesthesia. We searched the Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar (January, 2017 to June, 2024). Search terms included "Anesthesia", "Robotics", "prostatectomy", hysterectomy", "nephrectomy", "cholecystectomy" and "cystectomy" with the Boolean operators "AND" and "OR". We searched for randomized controlled trials (RCTs) including adults of both genders aged 18 years and above, who underwent transabdominal robotic-assisted laparoscopic surgery and targeting the consequences related to TIVA or inhalational anesthesia. We reviewed titles and abstracts and proceeded to full-text articles of the eligible studies relevant to inclusion criteria. Mean and standard deviations with 95% CI were calculated. Forest plots were used to present data visually. Six studies (340 patients) were included. We found only one study in which post-operative pain was assessed and results favored intravenous anesthesia in robotic transabdominal surgery. Only two studies reported post-operative nausea and vomiting (PONV). Both studies stated that PONV is reported in few patients in the inhalation anesthesia group. We found evidence suggesting that change in ONSD measurements at 10 min after induction (MD 0.04,95% CI -0.02 to 0.11 p = 0.19) and 40-60 min after Trendelenburg position (MD -0.26, 95% CI -0.34 to 0.17, p = 0.16) are much less in intravenous anesthesia group than in inhalation anesthesia group. Total intravenous anesthesia maintains the ONSD and hence the ICP better than inhalational anesthesia in robotic transabdominal surgery with CO2 pneumoperitoneum in Trendelenburg positioning requirements. It would be a safer choice than inhalational anesthesia due to fewer adverse events. This review concludes that TIVA is a better choice than inhalational anesthesia for transabdominal robotic-assisted surgery in urology, gynecology, and gastroenterology in both male and female patients.
Posterior urethral valves (PUV) are the most common cause of congenital bladder outlet obstruction in boys and may result in long-term impairment of both bladder and renal function. In addition to the obstructive process itself, concomitant congenital anomalies may further influence renal outcome. This study aimed to evaluate the spectrum of associated congenital anomalies in children with PUV and to examine their relationship with clinically significant chronic kidney disease (CKD) during follow-up. This retrospective single-center observational study included 103 boys with cystoscopically confirmed PUV who were diagnosed and followed at the Pediatric Urology Clinic of Eskişehir Osmangazi University Faculty of Medicine between January 2014 and December 2024. Patients with incomplete records or follow-up shorter than 12 months were excluded. Demographic characteristics, antenatal findings, presenting symptoms, vesicoureteral reflux (VUR), associated anomalies, imaging findings, interventions, bladder assessment findings, and renal outcomes were reviewed. Descriptive statistical analysis was performed. Clinically significant CKD was defined as persistent estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m² for more than 3 months, corresponding to CKD stage ≥ 2. The median age at diagnosis was 2.4 years. Antenatal hydronephrosis and/or hydroureteronephrosis was present in 42 patients (40.8%), and concomitant VUR was detected in 39 (37.9%). Associated anomalies included hypospadias in 7 patients (6.8%), ureteropelvic junction obstruction in 7 (6.8%), renal hypodysplasia in 5 (4.9%), spina bifida in 5 (4.9%), anorectal malformation in 4 (3.9%), and trisomy 21 in 1 (1.0%). During follow-up, 8 patients (7.8%) developed CKD stage ≥ 2. Most of these patients had antenatal hydronephrosis, high-grade VUR, dysplastic or non-functioning kidneys, or additional congenital anomalies. In this cohort, clinically significant CKD developed in a minority of children with PUV, but adverse renal outcome was concentrated in patients with severe upper urinary tract abnormalities and additional congenital anomalies. High-grade VUR, reduced functional renal mass, and complex associated anomalies appear to be important markers of poor renal prognosis. Careful long-term multidisciplinary follow-up remains essential in this patient group.
Pelvic ring injuries are frequently associated with genitourinary trauma, particularly bladder injury, traditionally considered proportional to fracture displacement. Minimally displaced anterior-posterior compression (APC I) fractures are often regarded as low risk. However, high-energy trauma may cause significant soft-tissue injury even when skeletal displacement is minimal. This study evaluated the incidence, characteristics, and outcomes of bladder injury in minimally displaced APC I fractures and identified associated risk factors, including dynamic instability. We retrospectively reviewed 180 adult patients with APC I fractures undergoing operative fixation after dynamic stress examination under anesthesia confirmed instability, at a high-volume pelvic trauma center (2020-2024). Data included demographics, mechanism of injury, intraoperative findings, bladder injury type, operative parameters, and functional outcomes. Bladder integrity was assessed intraoperatively and repaired primarily by urology. Associations between bladder injury and clinical, radiographic, and biomechanical factors, including pubic diastasis, sacroiliac widening, and pubic rami configuration, were analyzed. Bladder injury occurred in 27 patients (15%), involving the dome (41%), body (37%), or neck (22%). High-energy mechanisms accounted for 95% of injuries, including motor vehicle (47%) and motorcycle (26%) collisions, falls from height (15%), and pedestrian accidents (7%). Female patients had a higher relative incidence (18% vs. 13%, p = 0.04). Bladder injury correlated with longer operative time, increased blood loss, greater dynamic pubic symphyseal diastasis, sacroiliac widening, and high-energy trauma. Pubic rami separation or rotation also signaled increased soft-tissue risk. All injuries were repaired successfully, and functional outcomes were comparable between groups. Even minimally displaced APC I fractures may conceal clinically significant bladder trauma, particularly after high-energy mechanisms. Reliance on radiographic displacement alone may underestimate soft-tissue injury risk. Intraoperative vigilance, direct bladder inspection, and timely urologic repair are essential for optimal outcomes. Recognition of this phenomenon can guide risk stratification and improve perioperative management in pelvic trauma. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of orthopaedic department of Cairo University (Approval No. [N3032025]).
Urothelial carcinoma is a common malignancy of the urinary tract and occurs predominantly in elderly men. Although surgery, chemotherapy, and radiotherapy remain the main treatment options, their efficacy in advanced disease is often limited, particularly in elderly patients with comorbidities or poor surgical tolerance. Antibody-drug conjugates (ADCs) combined with immune checkpoint inhibitors have recently emerged as a promising therapeutic strategy. We report the case of a 79-year-old man with advanced urothelial carcinoma who declined radical cystectomy and received disitamab vedotin plus toripalimab. Histopathological examination confirmed high-grade muscle-invasive urothelial carcinoma, and supplementary immunohistochemistry showed HER2 expression of 1+. FISH/ISH and PD-L1 testing were not performed. The patient received treatment every 3 weeks over 2 consecutive days, with disitamab vedotin on day 1 and toripalimab on day 2. After 6 cycles, imaging showed marked tumor regression, and repeat transurethral resection of the tumor bed revealed no residual tumor cells, consistent with pathological complete response. The treatment was generally well tolerated, with only mild fatigue and nausea. This case suggests that disitamab vedotin combined with toripalimab may have activity in selected patients with advanced urothelial carcinoma, including those with low HER2 expression. However, the findings should be interpreted cautiously, and further studies are needed to clarify the role of this regimen and the value of predictive biomarkers.
Whole breast moderate hypofractionation is recommended for most breast cancer populations to improve survival and reduce recurrence. Whole breast ultra-hypofractionation and external beam accelerated partial breast irradiation (APBI) may reduce toxicity while maintaining benefits. MEDLINE and Embase searches through March 2024 identified randomized controlled trials (RCTs) evaluating adjuvant external beam hypofractionated radiation therapy for breast cancer. Eligibility and risk of bias (RoB) were assessed by two reviewers and required consensus. For prioritized outcomes (e.g., overall survival, acute toxicity), certainty of evidence was assessed using GRADE. Thirty-nine RCTs compared whole breast moderate hypofractionation vs. conventional radiation (CFRT; k = 25); whole breast ultra-hypofractionation vs. moderate hypofractionation or CFRT (k = 8); or external beam APBI vs. whole breast radiation (k = 6). For all comparisons, there were low RoB, large trials (N > 2,000) with 5-10 year outcomes. Trials on ultra-hypofractionation and APBI focused on early stage cancer, some also including ductal carcinoma in situ (DCIS). High survival (> 90%) and low recurrence were found across all treatments. Moderate hypofractionation probably results in less overall acute toxicity, but makes little to no difference in specific adverse events. No trial on ultra-hypofractionation reported overall toxicity; evidence on acute skin toxicity is very uncertain. APBI probably results in less overall acute toxicity, but may result in more overall late toxicity; evidence was very uncertain or showed no difference for specific events. Radiation treatments had similar survival and recurrence. Moderate hypofractionation and APBI result in lower overall acute toxicity, but evidence is lacking for ultra-hypofractionation. For ultra-hypofractionation and APBI, future research is needed to better understand late toxicity outcomes, and whether effects may vary across settings and subgroups.
Peritonitis is the most common and serious complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) in children. Understanding the interaction of host, agent, and environmental factors-based on the epidemiologic triad-may help reduce its incidence in pediatric populations, especially in resource-limited settings. This study aimed to evaluate host and environmental factors associated with peritonitis among pediatric CAPD patients while descriptively characterizing the causative microorganisms involved. This retrospective study included 35 pediatric patients receiving CAPD from 2019 to 2024. Clinical, socioeconomic, nutritional, and environmental data were collected. Peritonitis diagnosis followed ISPD criteria. Peritonitis incidence and peritonitis-free survival were analyzed using Kaplan-Meier curves and bivariate statistical tests. Eleven patients (31.4%) developed peritonitis, with an overall rate of 4.5 episodes per 100 person-months. Low dietary diversity, well water consumption, and low paternal education or labor/driver occupations were associated with higher peritonitis occurence (p < 0.05). Kaplan-Meier analysis showed that low dietary diversity significantly reduced peritonitis-free survival (p = 0.021). Trends were observed for water source and occupation. Peritonitis in pediatric CAPD patients results from a multifactorial interplay of nutritional, environmental, and socioeconomic factors. Addressing these determinants through dietary support, hygiene education, and socioeconomic assistance may help reduce peritonitis risk and support better outcomes.
Robot-assisted radical prostatectomy (RARP) requires a stable pneumoperitoneum to maintain optimal surgical conditions. The AirSeal® Intelligent Flow System has been developed to provide continuous pressure regulation and smoke evacuation; however, its clinical impact during RARP remains incompletely defined. To compare perioperative, oncological, and postoperative recovery outcomes between the AirSeal system and conventional insufflation systems during RARP. We retrospectively analyzed patients who underwent RARP at a high-volume tertiary center in a retrospective before-and-after cohort design. Patients were stratified according to the insufflation system used during surgery: conventional insufflation system (CIS) or the AirSeal system. Demographic characteristics, perioperative parameters, pathological outcomes, postoperative complications (Clavien-Dindo), postoperative pain scores and opioid consumption were evaluated. A total of 749 patients were included (CIS: 398; AirSeal: 351). Baseline demographic and clinical characteristics were comparable between the groups. Operative time was significantly shorter in the AirSeal group (183 ± 77.7 vs. 217.4 ± 73.0 min; p < 0.001). Estimated blood loss, transfusion rates, and length of hospital stay were similar between the groups. Pathological stage distribution differed between the groups, with a higher proportion of locally advanced disease (≥pT3) in the AirSeal cohort (49.3% vs 39.2%; p = 0.005). However, other oncological outcomes, including pathological ISUP grade distribution, lymph node involvement, and positive surgical margin rates, were comparable. Overall postoperative complication rates were similar between the groups; however, high-grade complications (Clavien-Dindo ≥III) occurred less frequently in the AirSeal group. Postoperative pain scores at 1, 6, and 24 hours were significantly lower in the AirSeal group (all p < 0.001), postoperative morphine consumption at 24 hours was also significantly reduced (p < 0.001). Use of the AirSeal insufflation system during RARP was associated with shorter operative times, lower postoperative pain scores, and less frequent high-grade complications. Positive surgical margin rates and lymph node involvement were comparable between the groups. However, given the retrospective before-and-after design, differences in surgical periods and pneumoperitoneum pressure between the groups, these findings should be considered observational and hypothesis-generating.
Studies have shown that poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitors can potentiate the antitumor effect of abiraterone acetate plus prednisone (AA-P) in metastatic castration-resistant prostate cancer (mCRPC). This study evaluated the pharmacokinetics, safety, and efficacy of fuzuloparib, a PARP inhibitor, in combination with AA-P in mCRPC patients who had not received prior novel hormonal agents. This was a dose escalation and expansion study. In dose escalation, eligible patients received fuzuloparib at 100 or 150 mg BID for 5 days, followed by fuzuloparib plus AA-P (abiraterone acetate 1000 mg QD, prednisone 5 mg BID) in 28-day treatment cycles. The higher tolerated dose of fuzuloparib was selected for dose expansion. In dose expansion, two treatment groups were planned. The fuzuloparib group received fuzuloparib for 5 days, and the abiraterone group received AA-P for 5 days. Both groups were then treated with the combination therapy. A total of 39 patients were enrolled and treated. As of July 12, 2023, the median follow-up time was 23.2 months (range, 3.9-44.3). No obvious drug-drug interaction was observed between 150 mg fuzuloparib and AA-P, and no dose-limiting toxicities were identified. Treatment-related adverse events (TRAEs) occurred in 36 (92.3%) patients, of which 20 (51.3%) reported grade ≥ 3 TRAEs. At the end of Week 12, prostate-specific antigen (PSA) response rate was 71.8% (95% CI, 55.1-85.0). The median time to PSA progression was 19.4 months (95% CI, 11.3-27.8). Objective response rate was 60% and disease control rate was 90% among patients with evaluable target lesions. The median duration of response was 8.1 months (95% CI, 4.6-31.5), and the median time to radiographic progression was 27.9 months (95% CI, 14.0-not reached). Time to disease progression was generally longer in patients with homologous recombination repair gene mutations, including those with BRCA mutations. Fuzuloparib plus AA-P had an acceptable safety profile and showed promising efficacy among mCRPC patients. ClinicalTrials.gov, NCT04108247 (Registered on September 26, 2019).
Endoscopic submucosal dissection (ESD) is a well-accepted endoscopic resection modality for early-stage gastrointestinal tumors. Over the past decades, progressive refinements in instruments, traction methods, and closure techniques have enhanced the safety and efficacy of ESD, and ESD further evolves into conventional ESD (C-ESD), traction-assisted ESD (T-ESD), and underwater ESD (U-ESD). The three modalities have their distinct benefits and are complementary to each other in clinical practice. At the same time, they compete with one another, presenting a challenge to operators with respect to which to select in specific scenarios. To conduct a network meta-analysis to make comparisons of the three approaches of ESD, with a focus on key endpoints including their operative duration, resection rate, R0 resection rate, and adverse event incidence. A computerized search was conducted across PubMed, Embase, Web of Science, and Cochrane Library databases. The literature was evaluated using the PRISMA 2020 framework. The netmeta package was used for pairwise and network meta-analysis. Continuous outcomes were pooled as mean differences, and dichotomous outcomes were pooled as risk ratios. When continuous data were reported as medians with interquartile ranges or ranges, values were converted to approximate means and standard deviations before pooling. Nine English-language randomized controlled trials involving 919 participants were included. The pooled absolute estimates showed that T-ESD and U-ESD had higher procedure speeds than C-ESD (19.61 and 18.99 vs. 15.20 mm2/min, respectively) and shorter median procedure times (55.02 and 58.51 vs. 70.20 min, respectively). For adverse events, the absolute rates were 7.8% for T-ESD, 6.3% for U-ESD, and 10.8% for C-ESD. For R0 resection, the corresponding rates were 92.0%, 92.0%, and 91.1%, and for en bloc resection they were 97.9%, 97.0%, and 96.0%. According to SUCRA ranking, T-ESD ranked highest for procedure speed (0.76), median procedure time (0.83), en bloc resection (0.87), and R0 resection (0.65), whereas U-ESD ranked highest for adverse events (0.78). These rankings were interpreted together with effect estimates and confidence intervals. Compared with C-ESD, U-ESD and T-ESD showed favorable trends for different procedural endpoints, but the certainty of superiority varied across outcomes. T-ESD ranked highest for procedure speed, median procedure time, en bloc resection, and R0 resection, whereas U-ESD ranked highest for adverse events. Because several dichotomous outcomes had confidence intervals crossing the null value, SUCRA-based rankings should be interpreted as comparative probability rankings rather than definitive proof of clinical superiority.
The host's immune response to Helicobacter pylori (H. pylori) infection is largely determined by its cytokine profile. Genetic variations within crucial immunomodulatory genes, including those for interleukin-10 (IL-10) and interleukin-12 (IL-12), are thought to influence an individual's vulnerability to the infection and its clinical consequences by modifying cytokine production. Nonetheless, research data derived from diverse human populations continue to show inconsistent results. This case-control analysis sought to examine a potential link between symptomatic H. pylori infection susceptibility in an Iranian population and specific genetic variants in the IL-10 (-1082G > A, -819 C > T) and IL-12 (+ 1188 A > C) genes. In this investigation, 68 individuals with confirmed symptomatic H. pylori infection diagnosed by a positive rapid urease test and elevated anti-H. pylori IgG levels exceeding 90 ng/ml via ELISA were enrolled alongside 68 healthy controls. The control group was carefully matched to the patient group based on age, sex, and ethnic background. Genotyping for the IL-10 (-1082G > A, -819 C > T) and IL-12 (+ 1188 A > C) polymorphisms was conducted using the Amplification Refractory Mutation System-PCR (ARMS-PCR) method. To evaluate associations, the distribution of genotypes and alleles between the groups was contrasted using logistic regression, applying additive, dominant, and recessive inheritance models. The strength of any association was expressed as odds ratios (ORs) accompanied by 95% confidence intervals (CIs). The analysis revealed no statistically significant correlations linking the investigated IL-10 and IL-12 gene variants to an increased predisposition for H. pylori infection. A notable methodological observation was the deviation from Hardy-Weinberg equilibrium (HWE) across all studied polymorphisms in the control group. Regarding the IL-10 -1082G > A locus, the AA genotype was associated with a marginally elevated risk estimate; however, this finding was not statistically significant (OR = 3.45, 95% CI: 0.29-41.36; p = 0.327). Likewise, for the IL-12 + 1188 A > C polymorphism, the CC genotype, while more prevalent in the patient cohort, also demonstrated no significant association with infection risk (OR = 1.43, 95% CI: 0.42-4.87; p = 0.567). This investigation did not establish a significant link between the specific IL-10 and IL-12 gene variants analyzed and susceptibility to symptomatic H. pylori infection in the studied population. Although minor genetic associations were noted, they lacked statistical significance. Future research with larger sample sizes is required to validate these results and to investigate additional genetic determinants that may affect infection risk.
Non-muscle-invasive bladder cancer (NMIBC) is characterized by a high recurrence rate requiring lifelong cystoscopic surveillance. Existing urine-based molecular assays mainly rely on mutations or methylation, which fail to capture large-scale genomic instability. Copy number variation (CNV) profiling offers complementary information on tumor evolution and aggressiveness, but its application in urinary diagnosis remains limited. We aimed to integrate CNV and DNA methylation signals from urinary DNA to establish a noninvasive and biologically informed stratified diagnostic model for NMIBC recurrence surveillance and risk stratification. Urine samples were prospectively collected from 91 patients (75 evaluable) between June 2021 and August 2023. Shallow whole-genome sequencing (sWGS) was used to detect CNVs at chromosomal arm and focal gene levels, while ONECUT2 promoter methylation was quantified by qPCR. Diagnostic and prognostic performance was evaluated by ROC analysis, Kaplan-Meier survival, and stratified recurrence assessment. We evaluated a stratified diagnostic model combining CNV and ONECUT2 methylation testing in a cohort of 79 patients. CNV analysis alone showed high specificity (0.923) for NMIBC diagnosis. A combined model, using CNV as an initial screen followed by ONECUT2 methylation testing in CNV-positive cases, achieved a sensitivity of 0.783, specificity of 0.981, and a negative predictive value (NPV) of 0.911. This approach reduced the number of required ONECUT2 tests by 35% and identified a high proportion of true-negative patients (98.1%), which may help reduce unnecessary cystoscopy procedures. The model also demonstrated significant prognostic value, with the molecularly defined high-risk group showing significantly shorter recurrence-free survival (RFS) than the low-risk group (median RFS: 4.33 months vs. not reached; p < 0.001). Additional, in patients with initially negative cystoscopy after urine sample collection, the model demonstrated a predictive accuracy of 0.922 for recurrence, with molecular positivity observed a median of 9.6 months prior to clinical diagnosis. Integrating CNV and DNA methylation profiling from urinary DNA provides a powerful and noninvasive molecular framework for NMIBC surveillance. By combining early epigenetic changes with genomic instability signals, this approach enhances recurrence risk assessment and enables earlier detection compared with conventional cystoscopy. It offers a practical route toward personalized and adaptive post-treatment monitoring of NMIBC. NCT04994197.
The association between tertiary lymphoid structures (TLS) and clinical outcomes in bladder cancer (BCa) patients, particularly their value in predicting immunotherapy response, remains inconsistent and has not been systematically evaluated. This systematic review and meta-analysis aimed to: (1) evaluate the association between TLS and survival outcomes in BCa; (2) examine the relationship between TLS and clinicopathological characteristics; and (3) summarize evidence on TLS and immunotherapy response. We systematically searched PubMed, Embase, and Web of Science from inception to February 1, 2026. Hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) were extracted and pooled. The study protocol was registered with PROSPERO (CRD420261282595). Eight studies involving 1706 patients were included in the quantitative synthesis. Pooled analysis revealed that high TLS levels were significantly associated with improved OS (HR = 0.49, 95% CI: 0.33-0.74), PFS (HR = 0.51, 95% CI: 0.45-0.58), and DFS (HR = 0.42, 95% CI: 0.22-0.79). TLS showed a significant correlation only with tumor multiplicity among various clinicopathological features. Qualitative synthesis of six studies suggested that while baseline TLS had limited predictive value for immunotherapy response, therapy-induced increases in TLS number, density, and maturation were consistently associated with favorable treatment outcomes. High TLS levels are associated with favorable survival outcomes in bladder cancer patients, supporting their role as a prognostic biomarker. Therapy-induced TLS dynamics, rather than baseline status alone, may be a more relevant predictive biomarker for immunotherapy efficacy. These findings warrant validation in larger, prospective studies.
To assess the potential of urinary exosomal miRNA as a predictor of kidney scarring in children with vesicoureteral reflux (VUR). A prospective study was conducted in pediatrics diagnosed with VUR between September 2023 to December 2025. Urinary exosomes were isolated from patients via ultracentrifugation and subsequently characterized using transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA) and Western blot. The expression levels of exosomal miRNAs were profiled using miRNA sequencing and validated by quantitative real-time PCR. Kidney scarring was determined based on dimercaptosuccinic acid (DMSA) scintigraphy, and its association with the identified urinary exosomal miRNAs was investigated. This prospective study enrolled 81 patients, comprising 33 males and 48 females, with a median age of 27 months (IQR: 8-82). Urinary exosomal miR-132-3p expression was significantly associated with higher reflux grade, bilateral reflux, and the presence of kidney scarring. Multivariate logistic analysis showed that urinary exosomal miR-132-3p (OR = 4.937, 95% CI: 1.906-12.781, P < 0.001) was a significant predictor of kidney scarring with a high predictive value with an area under the curve (AUC) of 0.908 (95% CI: 0.823-0.961, P < 0.001). In this exploratory single-centre cohort, urinary exosomal miR-132-3p serves as a promising non-invasive biomarker for the prediction of kidney scarring in children with VUR.
The comparative adoption of the Hugo™ robotic-assisted surgery platform for robot-assisted radical prostatectomy (RARP) is increasing; however, the strength and consistency of prospective head-to-head evidence versus da Vinci® remain uncertain. We performed a systematic review and meta-analysis of prospective comparative studies comparing Hugo™ RAS with da Vinci® for localized prostate cancer, incorporating sensitivity analyses and GRADE certainty assessments. We searched PubMed, Embase, Scopus, Web of Science, CENTRAL, and ClinicalTrials.gov databases from inception to January 2026. Prospective comparative studies enrolling patients with localized prostate cancer undergoing RARP with Hugo™ versus da Vinci® were included in this review. Screening and extraction were performed in duplicate with consensus resolution. Random-effects meta-analyses were performed, and risk of bias was assessed using ROBINS I and certainty using GRADE. Three prospective comparative studies comprising 145 Hugo RAS cases and 145 da Vinci cases were included. The primary outcome, intraoperative complications, showed no statistically significant difference between Hugo™ RAS and da Vinci®; however, the estimate was imprecise with a wide confidence interval, reflecting limited statistical power and uncertainty around the true effect size (RR 1.95, 95% CI 0.49-7.72; I² 0%). Secondary outcomes also showed no statistically significant differences, including positive surgical margin (RR 1.20, 95% CI 0.49-2.98), operative time (MD - 15.34 min, 95% CI - 41.11 to 10.43), estimated blood loss (MD - 39.09 mL, 95% CI - 143.51 to 65.32; I² 90%), length of stay (MD 0.10 days, 95% CI - 0.02 to 0.22), and catheter duration (MD 0.01 days, 95% CI - 3.97 to 3.99; I² 92%). Leave-one-out sensitivity analysis reduced heterogeneity in blood loss after removing a single study and shifted the pooled estimate toward lower blood loss with Hugo™. The certainty of evidence ranged from moderate to very low, most often downgraded for risk of bias, imprecision, and inconsistency. In the currently available prospective comparative evidence, Hugo™ RAS showed no statistically significant difference from da Vinci® RARP for perioperative safety and early postoperative outcomes in localized prostate cancer. However, the small sample size, sparse events, and wide confidence intervals, particularly for intraoperative complications, preclude conclusions of clinical equivalence or non-inferiority. Larger multicenter prospective comparative studies with standardized outcome definitions and longer oncologic and functional follow-up are required to generate higher-certainty evidence.