While robotic surgical training is crucial for preparing skilled surgeons, the landscape of available training programs is not well-defined. Many institutions offer structured curricula, yet transparency about training modalities, caseloads, and eligibility criteria for novice surgeons is limited. To address this gap, a structured survey was designed to assess robotic education offerings globally. A web-based survey was distributed to different robotic societies, institutions and dedicated robotic surgery experts, based on the Junior European Association of Urology Robotic Section (J-ERUS) network and the Young Academic Urologists (YAU) Robotic Section between February and September 2024. Furthermore, a peer-esteem snowballing approach allowed the survey to expand its reach through expert referrals. The survey captured information on training modalities, infrastructure, caseload, and case mix. Respondents were required to provide contact details for further follow-up, while their identities and institutions remained confidential. The survey achieved a 16.5% response rate, with 80 respondents from 49 institutions confirming robotic training opportunities. Training platforms included Da Vinci multi-port systems (71%), HUGO-RAS (15%), and Versius (8%). Training methods featured simulators (89%), dual-console training (65%), dry-labs (39%), and wet-labs (16%). Variability in training structures was observed, with 32% of institutions offering dedicated fellowships and 68% combining training with clinical duties. Institutions varied in case volumes (100-500 cases per year), and 41% indicated performing over 500 robotic procedures annually. Respondents predominantly answered that robotic surgery novices may access about 20% of these cases. This study highlights the heterogeneity of robotic surgical education and the need for standardized, globally accessible training frameworks. Establishing an international consortium to map training programs and content could enhance transparency and support novice surgeons in selecting institutions that align with their career goals. It is critical to integrate emerging robotic platforms and evolving methodologies into curricula to ensure comprehensive and effective training.
Robot-assisted radical cystectomy (RARC) is globally accepted, but single-surgeon, high-volume data linking perioperative factors with long-term oncologic outcomes are limited. We retrospectively reviewed 304 consecutive RARC cases performed by one surgeon between 2007 and 2024. Total intracorporeal urinary diversion (ICUD) was used in 73.0% of patients and orthotopic neobladder (ONB) reconstruction in 64.5%. Median follow-up was 51.21 months. Primary endpoints were overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Secondary endpoints included complication profiles and pentafecta, defined as margin-negative resection, ≥16 or more lymph nodes, no Clavien-Dindo grade ≥3 or higher complication within 90 days, no recurrence within 12 months, and no ureteroenteric stricture. Mean operative time was 447.61 minutes, median lymph-node yield was 31.0 in the extended PLND group and 24.0 in the standard PLND group, and the positive margin rate was 1.0%. ICUD was associated with shorter hospitalization than extracorporeal diversion (13.81 days vs. 17.03 days, p=0.026) and fewer early high-grade complications. Seven-year OS, CSS, and RFS were higher in pentafecta achievers (69.3%, 94.2%, and 82.6%), and 7-year OS was also superior in patients with organ-confined (≤T2) and node-negative disease (69.0% vs. 28.6% and 67.5% vs. 19.4%). Complications occurred in 59.7% overall, with 14.9% major; infections were most common (20.7%). In a high-volume single-surgeon series, RARC with ICUD provided durable oncologic control, acceptable morbidity, and high pentafecta achievement. Pathologic T and N stage and pentafecta were significant prognostic indicators that may assist in refining patient selection, guiding postoperative surveillance, and informing survivorship care.
preclinical trial confirmed that Angelica gigas and Astragalus membranaceus had a curative effect on benign prostatic hyperplasia (BPH). Therefore, this study aimed to investigate the effects of this compound in patients with BPH symptoms. Subjects were divided into the treatment and control groups. They underwent four visits, and medication was initiated from the 2nd visit onwards, with a total of 12 weeks of intake. The endpoints were the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), prostate-specific antigen level, testosterone, dihydrotestosterone, maximal urinary flow rate, residual urine volume, and subjective evaluation improvement. Safety tests included clinical pathology tests and checking for adverse reactions. A total of 39 patients from the treatment group and 45 from the control group were included in the efficacy analysis. After 12 weeks, a significant improvement was seen in IPSS total score (p=0.0219) and incomplete emptying score (p=0.0007). Furthermore, there were statistically significant improvements in the IIEF total score, erectile function, sexual desire, intercourse satisfaction, and overall satisfaction in the treatment group. The subjective improvement evaluation also showed a significant improvement (p=0.0143). Ten cases of mild adverse events were reported, including gastrointestinal problems, skeletal pain, dermatitis, and others. However, no severe adverse reactions were observed, and it was unlikely that these were related to the test product. After taking the trial product (SHPro®) for 12 weeks, the total and incomplete emptying IPSS improved, as did the IIEF, which indicated subjective improvements. And its safety was confirmed.
Effective treatments are needed for patients with muscle-invasive bladder cancer scheduled for radical cystectomy who are ineligible for or decline to receive neoadjuvant cisplatin-based chemotherapy. We aimed to evaluate neoadjuvant TAR-200 plus cetrelimab (anti-PD-1) versus cetrelimab monotherapy in this setting. SunRISe-4 is a randomised, open-label, phase 2 trial being conducted at 109 investigative centres in ten countries worldwide. Eligible patients were aged 18 years or older, were newly diagnosed with histologically confirmed muscle-invasive bladder cancer (stage cT2-cT4 N0M0), had an Eastern Cooperative Oncology Group performance status of 0-1, were scheduled to undergo radical cystectomy, and were deemed ineligible for or declined platinum-based neoadjuvant chemotherapy. Patients were randomly assigned (5:3) in blocks of eight using an interactive web response system to receive four cycles of intravesical TAR-200 (225 mg gemcitabine) plus intravenous cetrelimab (360 mg) every 21 days or four cycles of intravenous cetrelimab (360 mg) monotherapy every 21 days. Randomisation was stratified by results of transurethral resection of bladder tumour (visibly complete vs incomplete and ≤3 cm) and tumour stage (cT2 vs cT3-4a at initial diagnosis). The primary endpoint was centrally confirmed pathological complete response in the efficacy-evaluable set. As this was a prespecified interim analysis and all patients had not completed treatment, efficacy-evaluable set was defined as all patients who had radical cystectomy or progressive disease or death before radical cystectomy. Safety was analysed in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT04919512, and is ongoing. From July 7, 2022, to May 31, 2024, 196 patients were assessed for eligibility and 122 were randomly assigned (TAR-200 plus cetrelimab n=80, cetrelimab monotherapy n=42). 120 patients received at least one dose of study drug. Mean age was 70·7 years (SD 7·9); 102 (85%) participants were male, 18 (15%) were female, 81 (68%) were White, 28 (23%) were Asian, and 11 (9%) were other races. In the efficacy-evaluable set (TAR-200 plus cetrelimab n=53, cetrelimab monotherapy n=31), at a median follow up of 23·5 weeks (IQR 8·6-42·0), pathological complete response rates were 42% (22 of 53 patients; 95% CI 28-56) in the TAR-200 plus cetrelimab cohort and 23% (seven of 31 patients; 10-41) in the cetrelimab monotherapy cohort. In the safety set, at a median follow-up of 10·2 weeks (IQR 1·1-36·9), treatment-related adverse events occurred in 57 (72%) of 79 patients in the TAR-200 plus cetrelimab cohort and in 18 (44%) of 41 patients in the cetrelimab monotherapy cohort. Grade 3 or worse treatment-related adverse events occurred in nine (11%) patients in the TAR-200 plus cetrelimab cohort and two (5%) in the cetrelimab monotherapy cohort, the most common being haematuria (two [3%] in the TAR-200 plus cetrelimab cohort). Serious treatment-related adverse events occurred in nine (11%) patients in the TAR-200 plus cetrelimab cohort and one (2%) patient in the cetrelimab monotherapy cohort. In the TAR-200 plus cetrelimab cohort, seven (9%) patients had treatment-related adverse events leading to discontinuation of TAR-200 and six (8%) had treatment-related adverse events leading to discontinuation of cetrelimab; there were no treatment related deaths. In the cetrelimab monotherapy cohort, no patients discontinued due to treatment-related adverse events; there was one death from a treatment-related adverse event due to hyperglycaemic, hyperosmolar, non-ketotic syndrome. Neoadjuvant TAR-200 plus cetrelimab showed a high pathological complete response rate with a manageable safety profile. These results support continued investigation of TAR-200 in patients with muscle-invasive bladder cancer planned for radical cystectomy. Johnson & Johnson.
Percutaneous nephrolithotomy (PCNL) necessitates that the urologist comprehensively understands the stone's location and its relation to the intrarenal anatomy. We evaluated the use of virtual reality (VR) as a preoperative tool for planning for PCNL surgery and its assessment for training among residents in PCNL. This prospective, randomized control trial took place between May 2021 to June 2022. Resident and consultant surgeons rated their understanding of the anatomy with computed tomography (CT) alone and after CT+VR. The CT scans from patients randomized to the intervention group created a patient-specific three-dimensional VR model (Anatomage software version 6.02). The trial enrolled 90 participants and was randomized to the control group (CT alone) and the VR group. The mean age of the participants was 42.09±13.48 years. There were 63 males (70.0%) and 27 females (30.0%). Residents had an improved understanding of the location of the stone, size of the stone, shape, orientation of the calyx, optimal entry of the calyx, and navigation. Residents had a better ability to formulate a surgical plan with VR models. The consultant surgeon's assessment showed CT and VR had non-significant results for understanding based on the above parameters. Preoperative evaluation in patients in the VR group with S.T.O.N.E score >8 showed a statistically significant better understanding of consultants (p<0.05). They recommend VR to colleagues if patients have a S.T.O.N.E score >8 (p<0.05). VR improved the understanding of PCNL for residents in all cases and consultants in complex anatomy cases.
To investigate the association between metabolic syndrome (MetS) and nocturia in a nationally representative U.S. adult population, focusing on individual metabolic components and subgroup differences by age and sex. We analyzed data from 8,518 adults aged ≥20 years who participated in the National Health and Nutrition Examination Survey from 2005 to 2014. Nocturia was defined as ≥2 nighttime voids. MetS was defined by the presence of ≥3 National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariate logistic regression and restricted cubic spline (RCS) analyses were used to assess associations, adjusting for demographic and behavioral covariates. Overall, 23.3% of participants had MetS and 29.6% reported nocturia. MetS was independently associated with nocturia (adjusted odds ratio [OR] 1.387, 95% confidence interval 1.236-1.557). A dose-response relationship was observed, with nocturia risk increasing. Central obesity (OR 1.564), elevated fasting glucose (OR 1.397), and elevated blood pressure (OR 1.311) showed the strongest associations. RCS analyses revealed linear associations for waist circumference and systolic blood pressure, and nonlinear associations for diastolic blood pressure and glucose. Sex-specific analyses revealed distinct nonlinear patterns, particularly for waist circumference among male participants and triglyceride levels among female participants. The association remained consistent across most age and sex groups, except in males aged 20-40 years. MetS and its components are independently associated with nocturia. The observed sex-specific differences suggest that metabolic contributors to nocturia may differ by sex supporting nocturia as a potential clinical marker of underlying cardiometabolic dysfunction.
This study evaluated inter-/intra-reader agreement with the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 to improve the detection rate of prostate cancer. We enrolled 210 patients who underwent multiparametric magnetic resonance imaging (mpMRI) for clinically suspected or diagnosed prostate cancer. Four readers, including two urologists, viewed patients' mpMRI and scored PI-RADS between two sessions, including the time for feedback and training after the first reading session. Inter- and intra-reader agreements were evaluated using Fleiss' kappa coefficient (κ), agreement coefficient 1 (AC1), and percentage of agreement (PA). The overall inter-reader agreement between all readers was moderate (κ=0.466, AC1=0.522, and PA=0.610). The overall inter-reader agreement improved in the second session. The agreement for peripheral zone (PZ) lesions was higher than that for transitional zone (TZ) lesions. At a PI-RADS cut-off of 4, the agreement for PZ lesions was almost perfect (PA=0.888) and higher than that for TZ lesions. The inter-reader agreement for lesions with a PI-RADS ≥4 and Gleason score ≥7 was almost perfect (AC1=0.960 and PA=0.964). The intra-reader agreement for lesions overall and PI-RADS ≥4 lesions were substantial (AC1=0.601) and almost perfect (PA=0.876), respectively. Readers achieved moderate agreement for PI-RADS version 2.1 and benefitted from training sessions. Feedback, training, and multidisciplinary discussions also improved inter-reader agreement. Our study can provide guidance, updates, and further steps for the standardization and improvement of PI-RADS scoring.
Active surveillance (AS) is recommended for men with low-risk prostate cancer, but institutional variability exists in eligibility criteria, confirmatory biopsy policies, and monitoring schedules. This study assessed whether protocol heterogeneity influences surveillance duration, treatment transition, and surgical pathology outcomes. We retrospectively reviewed 232 men who initiated AS between 2014 and 2016 at three institutions with distinct protocols: Hospital A (Gleason Grade Group [GGG] 1-2, prostate-specific antigen [PSA] <15 ng/mL, confirmatory biopsy only if clinically indicated), Hospital B (GGG 1-2 within core limits, PSA <20 ng/mL, biennial biopsy), and Hospital C (GGG 1 within core limits, one confirmatory biopsy within 1-2 years, then biopsy if clinically indicated). Kaplan-Meier and Cox regression assessed AS continuation and treatment transition, while final GGG and pathologic stage were compared among men undergoing radical prostatectomy (RP). Median AS duration was 38.5 months. Five-year AS retention differed significantly: 53.2% (Hospital A), 79.8% (Hospital B), and 59.1% (Hospital C). Treatment transition occurred in 23.2%, 18.1%, and 44.0% of patients, respectively (p=0.003). Hospital B showed the lowest hazard of transition (hazard ratio [HR] 0.49 vs. Hospital A), whereas Hospital C had a higher hazard for RP (HR 1.87 vs. Hospital A). Final GGG and stage did not differ among RP specimens. Institutional heterogeneity in AS protocols significantly influenced surveillance duration and treatment timing but not adverse pathology. Flexibility in protocol design may be acceptable if supported by confirmatory biopsy and risk-adapted monitoring, underscoring the need for evidence-based standardization.
Recurrent urinary tract infections (rUTIs) represent a significant clinical challenge, particularly among women and catheterized patients, leading to diminished quality of life and increased healthcare utilization. A central factor in rUTI pathogenesis is bacterial persistence despite seemingly appropriate antibiotic therapy. Unlike classical antibiotic resistance, persistence involves phenotypic adaptations that allow uropathogens to evade both host immune responses and antimicrobial agents. This review examines the multifactorial mechanisms underlying bacterial persistence, including intracellular survival strategies, biofilm formation, antibiotic tolerance, and host immune evasion. An improved understanding of these processes is essential for developing novel, targeted therapeutic strategies that go beyond traditional antimicrobial approaches and address the root causes of recurrence.
To evaluate whether repeated prostate-specific antigen (PSA) testing influences treatment patterns and healthcare costs for prostate cancer (PCa). We analyzed a nationwide insurance cohort of men newly registered with PCa from 2010 to 2020. Patients were classified as PSA-tested (≥3 tests across ≥2 years before registration) or PSA non-tested (first PSA test within 3 months before registration). We compared the initial and subsequent treatment patterns between localized and systemic therapies, and per-patient medical expenditures by treatment modality. The analyses focused on 2016 to 2020, when government-set prices stabilized. Primary endpoints were cumulative medical costs and downstream medical utilization patterns. Of the 166,848 men, 26.7% were PSA-tested, 42.2% were non-tested, and 31.1% were undetermined. Localized therapy was more frequent after repeated testing: surgery, 45.6% versus 33.8% (p<0.001); radiotherapy, 17.0% versus 14.9% (p<0.001); and focal therapy, 0.8% versus 0.3% (p<0.001). Systemic therapy predominated without prior testing: hormone therapy, 59.7% versus 42.3% (p<0.001), chemotherapy, 2.7% versus 1.0% (p<0.001), and androgen receptor-targeted agents, 1.4% versus 0.5% (p<0.001). For localized modalities delivered during 2016 to 2020, the per-patient costs of non-robotic surgery and radiation therapy were comparable between the groups. In contrast, expenditures for hormone therapy and androgen receptor-targeted agents were significantly higher in the PSA non-tested group, primarily reflecting a longer treatment duration rather than higher monthly spending. Once national prices stabilized, repeated PSA testing was associated with greater use of localized therapy and lower cumulative spending on prolonged systemic treatment without increasing the costs for localized modalities.
Bladder outlet obstruction (BOO) leads to detrusor overactivity (DO) and structural remodeling of the bladder. However, the molecular mechanisms underlying this process remain incompletely understood. In a rat model of partial BOO, we assessed bladder function via cystometry and evaluated histological changes using hematoxylin and eosin staining. The expression and localization of aquaporin (AQP)-2 and caveolin (CAV)-1, -2, and -3 were analyzed by Western blotting and immunofluorescence in bladder tissues. Additionally, immunostaining was performed in cultured human bladder smooth muscle cells to assess protein co-localization. BOO rats exhibited elevated detrusor contraction pressure and shortened intercontraction intervals. Histologically, hypertrophied smooth muscle bundles and increased extracellular matrix were observed. Western blot analysis revealed significant upregulation of AQP2 and CAV1-3 in BOO bladders. Tissue immunofluorescence demonstrated increased expression and redistribution of these proteins in the detrusor muscle. Cultured cell analysis confirmed subcellular co-localization of AQP2 with CAV1-3. DO induced by BOO is associated with upregulated expression of AQP2 and CAV1-3 in the urinary bladder. The coexpression observed in bladder cells suggests potential molecular interactions between AQP2 and CAVs that may contribute to the pathophysiology of BOO-related bladder dysfunction.
The prevalence of liver dysfunction among men has been steadily increasing in recent decades. Among the various non-invasive assessment tools available, the Fibrosis-4 (FIB-4) Index has emerged as a particularly valuable and widely adopted scoring system for evaluating liver fibrosis. This study investigated the relationship between liver fibrosis evaluated by the FIB-4 Index and male health care parameters. Participants were assessed using standardized questionnaires, including the International Prostate Symptom Score (IPSS) for lower urinary tract symptoms (LUTS), the Sexual Health Inventory for Men (SHIM) and EHS (Erection Hardness Score) for erectile function, and the AMS (Aging Males Symptoms rating scale) for late onset hypogonadism. Endocrinological parameters, including dehydroepiandrosterone sulfate (DHEA-S), insulin-like growth factor 1 (IGF-1), total testosterone and cortisol levels, as well as metabolic factors, including hemoglobin A1c (HbA1c) and triglyceride level, were evaluated as potential confounders. The patient age was 50.62±0.24 years. The analysis revealed significant associations between higher FIB-4 Index quintiles and worsening sexual function and LUTS. Among endocrine factors, DHEA-S and IGF-1 exhibited decreasing trends with higher FIB-4 Index values, whereas cortisol showed an increasing trend. Surprisingly, no significant association was observed between FIB-4 Index and testosterone levels. HbA1c increased, but triglycerides did not correlate with FIB-4. Multiple regression confirmed IPSS and SHIM scores were independently linked to the FIB-4 Index (p<0.05). These findings highlight the importance of hepatic assessment in men with erectile dysfunction and LUTS, supporting a multidisciplinary approach to care.
This study compared the real-world effectiveness of androgen receptor pathway inhibitors (ARPIs)-abiraterone acetate, apalutamide, and enzalutamide-as treatment intensification in patients with metastatic hormone-sensitive prostate cancer (mHSPC). This multicenter retrospective cohort study analyzed 219 patients with mHSPC who received first-line ARPIs combined with androgen deprivation therapy. We evaluated progression-free survival to metastatic castration-resistant prostate cancer (PFS to mCRPC) and prostate-specific antigen (PSA) response within 12 weeks and investigated the prognostic impact of early PSA response on clinical outcomes. The cohort comprised patients receiving abiraterone acetate (n=94, 42.9%), apalutamide (n=91, 41.6%), and enzalutamide (n=34, 15.5%) with an 18.8-month median follow-up. The 2-year PFS to mCRPC rates demonstrated no significant difference between the groups (abiraterone acetate: 74.1%; apalutamide, 81.4%; enzalutamide, 85.6%; p=0.482). However, apalutamide and enzalutamide achieved superior rates of PSA decline to ≤0.2 ng/mL within 12 weeks compared with abiraterone acetate (44.0% and 55.9% vs. 25.5%, respectively) and significantly shorter median time to PSA nadir (7.2 and 7.5 months vs. 12.2 months; p<0.001). A PSA reduction of ≥90% within 12 weeks was observed in 87.2%, 94.5%, and 97.1% of patients receiving abiraterone acetate, apalutamide, and enzalutamide, respectively. Multivariate analysis identified early PSA response as an independent prognostic factor for improved PFS to mCRPC regardless of ARPI selection. Abiraterone acetate, apalutamide, and enzalutamide showed comparable PFS to mCRPC outcomes, while significant differences in early PSA kinetics were observed, with early PSA response serving as a crucial prognostic factor in mHSPC patients.
Radical cystectomy (RC) is among the most complex procedures in urology, with early morbidity rates exceeding 50%. Understanding which complications occur most often and identifying their predictors may improve perioperative optimization and postoperative surveillance. This study aimed to determine the most common complications occurring within 30 days after RC and to identify their predictors. We conducted a retrospective observational study of all adult patients undergoing RC with urinary diversion at a single institution between January 2014 and December 2024. A total of 202 patients met inclusion criteria. The seven most frequent complications were identified. Univariable logistic regressions and three separate multivariable models were generated for each complication. Adjusted odds ratios with 95% confidence intervals were reported. Overall, 53.0% of patients experienced at least one complication within 30 days. The seven most frequent complications were ileus (25.7%), wound complications (18.8%), urinary tract infection (UTI) (18.3%), sepsis (13.4%), evisceration (11.9%), respiratory infection (5.9%), and bowel anastomotic leak (4.5%). Ileus was predicted by intraoperative complications and urinary diversion type. Wound complications were associated with higher Charlson comorbidity index (CCI), sepsis, ileus, and open surgery. Sepsis was predicted by hypertension, advanced-stage disease, ileus, wound complications, and bowel anastomotic leak. No independent predictors were identified for early UTI. Respiratory infection was associated with postoperative ileus. Evisceration was strongly associated with CCI, intraoperative complications, ileus, and bowel anastomotic leak. Early morbidity after RC remains high. Predictor profiles differed across complications, supporting the need for complication-specific perioperative strategies.
The robotic-assisted laparoscopic approach for creation of an appendicovesicostomy is in common practice now. We describe our modifications ("Gundeti's 10 step modification") to the conventional open technique for adopting the robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy (RALMA), and study our long-term outcomes. This was a retrospective review of prospectively collected data and electronic medical record review from 2008 to 2023. Children with failure to empty the bladder with normal bladder capacity who underwent RALMA incorporating our "Gundeti's 10 step modification" were included. The demographic, clinical, and postoperative details were analyzed. All were followed up annually, to monitor the continence and redo surgery rates. Success was defined as postoperative stomal continence and failure was considered in those who underwent redo procedures. Twenty-seven children were included with a mean age of 9.4 years. The mean hospitalization, estimated blood loss, and operative time were 5.27 days, 18.05 mL, and 236 minutes. The complications were suprafascial stenosis (11.1%), subfascial stenosis (3.7%), and channel incontinence (7.4%). Three children required redo procedures (11.1%). The mean follow-up was 69.41 months, and all 27 children are continent at the last follow-up (100.0%). Our proposed modifications, i.e., "Gundeti's 10 step modification" allows a success rate of 92.6% for continence and 89.0% based on redo surgery rates, thereby proving it to be a safe and feasible option amongst the paediatric population.
To develop and validate an artificial intelligence (AI)-based personalized outcome prediction model for upper-urinary tract urothelial carcinoma patients undergoing radical nephroureterectomy. Data from patients who underwent radical nephroureterectomy between 2010 and 2020 across three hospitals were retrospectively analyzed. A model was developed using one tertiary center's data and externally validated with data from two other hospitals. An AI model using XGBoost as risk estimator and bootstrapped Weibull Accelerated Failure Time model for 10-year survival probability was employed. Hyperparameter tuning used Optuna method. Model efficacy was assessed using concordance index, average Brier score, D-calibration, and six-month interval time-dependent area under the curve (AUC). Of 1,039 patients, 627 qualified after excluding 50 with neoadjuvant chemotherapy. Model development used 564 patients (507 training, 57 test) with 9:1 stratified random split, plus 63 for internal validation and 362 for external validation. Significant parameters included preoperative glomerular filtration rate (p<0.001), hydroureteronephrosis (p=0.013), pathological N stage (p<0.001), concurrent carcinoma in situ (p<0.001), disease progression (p<0.001), and survival rate (p<0.001). Disease-free survival (DFS) model's concordance index: internal validation 0.789, external validations 0.734 and 0.771. Overall survival (OS) model's concordance index: internal validation 0.819, external validations 0.780 and 0.771. Mean time-dependent AUC was 0.66-0.77 for DFS and 0.67-0.80 for OS during 10-year periods. AI-based model effectively predicts disease-free and OS outcomes for upper-urinary tract urothelial carcinoma patients with post-radical nephroureterectomy, showcasing robust performance across multicenter settings.
This study aimed to evaluate the safety, including blood pressure changes, and medication compliance associated with a generic prolonged-release formulation of mirabegron (Selebeta® PR Tab. 50 mg) in Korean adults with overactive bladder (OAB) through a large-scale, real-world, multicenter, retrospective observational study. Patients with OAB who were prescribed Selebeta® PR once daily for at least 3 months between July 2020 and July 2021 from 95 medical institutions in Korea were included. The primary endpoint was the proportion of patients with an increase in systolic blood pressure (SBP) of ≥10 mmHg after 3 months of treatment. Secondary endpoints included additional thresholds of blood pressure elevation, changes in SBP and diastolic blood pressure (DBP) and pulse rate over time, improvement in OAB symptom, incidence of adverse events, and medication compliance. A total of 2,091 patients were enrolled in the study. After 3 months of treatment, 8.8% of the patients had an SBP increase of ≥10 mmHg; 3.7%, ≥15 mmHg; and 2.3%, ≥20 mmHg. DBP increased by ≥5 mmHg in 16.8% and by ≥10 mmHg in 6.7% of patients. OAB symptoms also improved significantly in the subgroup with available OAB symptom score data. The overall incidence of adverse events was 2.1%, mostly mild, and mean medication coverage was 73.6%. This study demonstrated that Selebeta® PR is an effective and well-tolerated treatment for adults with OAB, with no clinically meaningful increase in blood pressure and a low incidence of adverse events.
Urinary tract infections (UTIs) are a known complication after cystectomy, but patients undergoing cystectomy for benign conditions represent an understudied population. This study quantified UTI rates after benign cystectomy (BC) and identified patient factors associated with infection. We reviewed all patients who underwent BC at our institution from 2012-2025, excluding those treated for malignancy. Cystectomy type and urinary diversion were recorded. UTIs required culture confirmation of >10⁵ colony-forming units and were categorized as occurring either during the immediate postoperative period before discharge or within 90 days after discharge. Demographics and perioperative characteristics were compared between patients with and without UTIs in each time frame. Among 183 patients undergoing BC, 27 (14.8%) developed an immediate postoperative UTI, and 35 (19.1%) developed a UTI within 90 days. Sixty patients (32.8%) received postoperative antibiotic prophylaxis (AP). AP was not associated with lower rates of immediate postoperative UTIs, and patients who developed a UTI within 90 days were more likely to have received AP (55.9% vs. 28.1%; p<0.05). Common pathogens included Enterococcus species, Escherichia coli, and Klebsiella pneumoniae. Patients with immediate postoperative UTIs had longer operative times (390 minutes vs. 340 minutes; p<0.05). Those with UTIs within 90 days were more frequently readmitted (94.3% vs. 26.1%; p<0.05). UTIs after BC are common both immediately postoperatively and within 90 days. AP did not reduce early UTIs and were associated with higher 90-day UTI rates. Further investigation is warranted to clarify risk factors and optimize prevention strategies.
This study aimed to compare the clinical outcomes of Aquablation and Holmium Laser Enucleation of the Prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH), with emphasis on functional improvement, ejaculatory preservation, and perioperative safety. We retrospectively analyzed data from January 2023 to March 2024, excluding patients with follow-up shorter than 3 months. Propensity score matching was performed using age, prostate volume, and preoperative prostate-specific antigen (PSA). Pre- and postoperative outcomes included International Prostate Symptom Score, Overactive Bladder Symptom Score, maximum flow rate (Qmax), post-void residual urine volume (PVR), PSA, and MSHQ-EjD (Male Sexual Health Questionnaire-Ejaculatory Dysfunction)-based ejaculatory grading (0-3). Paired t-tests, Wilcoxon signed-rank tests, McNemar's test, and Mann-Whitney U test were applied as appropriate. A total of 104 patients were included, with 34 matched pairs. Both procedures significantly improved lower urinary tract symptoms, with no significant differences in symptom score changes or PVR. HoLEP resulted in greater improvements in Qmax and PSA (p=0.011 and p<0.001, respectively). Aquablation demonstrated significantly better preservation of ejaculation (p=0.002). Although transient incontinence was more frequent in HoLEP and gross hematuria and urinary retention were more common in Aquablation, none of the complication rates showed statistically significant differences. Aquablation and HoLEP are both effective surgical options for BPH. Aquablation offers comparable symptom relief with significantly superior ejaculation preservation, making it particularly suitable for sexually active patients. HoLEP provides greater deobstructive efficacy, as evidenced by superior Qmax and PSA outcomes. These findings support individualized, patient-centered decision-making.
Owing to concerns about overdiagnosis and overtreatment associated with prostate-specific antigen (PSA) screening for early prostate cancer detection, recent guidelines have lowered the PSA cutoff value for recommending biopsy. This study aimed to evaluate the diagnostic accuracy of a lower PSA cutoff value in Korean men and to explore whether additional clinically useful criteria can be proposed. A retrospective cohort study of 17,539 Korean men who underwent their first prostate biopsy due to lower urinary tract symptoms was conducted at six tertiary hospitals between 2011 and 2019. The diagnostic performance of various PSA and PSA density (PSAD) cutoff values across age groups was evaluated by analyzing the data on demographics, PSA levels, PSAD, and biopsy results. Among the participants, 44.1% were diagnosed with prostate cancer, of whom 73.7% had clinically significant cancer (Gleason score ≥7). No significant differences in cancer detection rates were found between PSA levels of 3-4 ng/mL and 4-5 ng/mL across age groups. PSAD further increased the area under the receiver operating characteristic curve by 5.5%-11.4%. These findings suggest that diagnostic yield may not be impacted by merely lowering the PSA cutoff. Rather, combining PSA, PSAD, and patient age enhances screening accuracy while minimizing unnecessary biopsies and overdiagnosis. Our results highlight the need for more data to refine national screening guidelines and promote a more tailored approach to prostate cancer screening in Korea.