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The recommendations of the European association of urology (EAU) suggests treating the bladder phenotype with Hunner's lesion (HL) associated with bladder pain syndrome (BPS) by transurethral resection (TUR) or coagulation of the lesions. We present the results of this approach in our practice. Retrospective monocentric study including consecutive patients presenting BPS with HL assessed during cystoscopy between 1998 and 2026. Patients were divided in two groups according to treatment strategy: group 1 with medical management (association of Cimetidine or bladder instillations of RIMSO or Pentosan polysulfate de sodium (CRP)) and group 2 with surgical management (immediate TUR, repeated if pain and HL recurrence). The primary objective was to compare success of each management strategy, defined by complete resolution of pain. Secondary objectives were to describe efficacy on pollakiuria symptoms and morbidity of surgical management. Thirty-two patients were included (group 1 n=9, group 2 n=23). Success of treatment was achieved in 11.1% (1/9) cases in group 1 and in 78,2% (18/23) cases in group 2 (p=0.001). In group 1, the only pain resolution was observed after RIMSO bladder instillation. In group 2, 61,1% (11/18) experienced a pain recurrence after being cured with a median delay of 13 [6-30.25] months. 12 patients required a 2nd TUR. Resolution of pollakiuria occurred in 0% in group 1 and 34,8% (8/23) in group 2 (p=0.07). Three patients required reintervention after TUR, 2 for bladder perforation (1 open and 1 laparoscopic bladder repair), 1 for gross haematuria requiring coagulation and 12.5% (4/32) patients ultimately underwent cystectomy. in case of BPS with a bladder phenotype and one or more Hunner's lesions, treatment by transurethral resection of the inflammatory lesion is more effective for pain and, to a lesser extent, for pollakiuria than our usual medical treatment (CRP) but does not prevent recurrence after varying periods of time.

Interpretation of urine culture results requires key clinical information such as symptom status, catheterization, and multidrug-resistant organism (MDRO) risk. However, this information is frequently absent from routine request forms, contributing to overtreatment of asymptomatic bacteriuria (ASB) and suboptimal antimicrobial prescribing. This study evaluated the impact of implementing a structured urine-culture request form as part of a diagnostic and therapeutic stewardship program. This prospective, non-randomized interventional study was conducted at an 1800-bed tertiary-care hospital in India (March 2023-March 2024). Patients undergoing urine culture testing in Urology/Nephrology departments used a structured request form capturing symptoms, risk factors, and clinical context (test arm), while General Medicine continued routine forms (control arm). Primary outcomes included ASB treatment, MDRO detection, recurrence, and guideline-concordant prescribing. Patients were followed for one year. A total of 484 patients were included (198 test arm, 286 control arm). Antibiotic treatment for ASB was significantly lower in the test arm compared with the control arm (3.6% vs 67.0%; p < 0.001), without adverse outcomes. Guideline-compliant prescribing was higher in the test arm (73.7% vs 26.2%; p < 0.001). MDRO prevalence was higher in the test arm (32.2% vs 11.3%), reflecting greater clinical complexity rather than the intervention itself. Recurrent urinary tract infection (UTI) within one year was significantly lower in the test arm (14.1% vs 29.0%; p < 0.001). Introducing a structured urine-culture request form improved diagnostic clarity and antibiotic prescribing, particularly by reducing unnecessary treatment of ASB and increasing guideline compliance, without compromising patient outcomes. This low-cost intervention represents a practical and scalable diagnostic stewardship strategy for improving UTI management.

Female urethral stricture (FUS) is a rare but significant cause of bladder outlet obstruction, often leading to urinary retention, recurrent UTIs and other complications. Conventional treatment like urethral dilation provides temporary relief but has a high recurrence rate. Intermittent bladder catheterization (IBC) is a promising adjunct following dilation that may reduce recurrence by maintaining urethral patency and preserving bladder health. Despite its effectiveness in managing urethral strictures, there is limited evidence regarding its implementation in female populations particularly as a nursing intervention. This study aimed to evaluate the impact of intermittent bladder catheterization (IBC) on reducing the recurrence of urethral strictures in female patients following urethral dilation. A randomized controlled trial was conducted at the Urology Department of Shaikh Zayed Hospital, Lahore, from May 2024 to December 2024. A total of 56 female patients (aged 35-55 years) were recruited and randomized into two groups: the intervention group (n=28), which performed IBC twice daily at home under nursing supervision, and the control group (n=28), which received standard post-dilation follow-up without IBC. Stricture recurrence was assessed over a follow up of 12 weeks through periodic catheterization using a 14Fr Nelton catheter. Relative risk and absolute risk of recurrence reduction was calculated. Confidence interval of 95% was calculated for all estimates. For data analysis, Chi-square test, independent t-test and repeated measure ANOVA were used. The recurrence rate was significantly lower in the intervention group compared to control (7.14% vs 28.57%, p = 0.03). The relative risk of recurrence was 0.25 (95%CI: 0.06-0.98), indicating a 75% reduction in recurrence with intermittent bladder catheterization. Nurse-led intermittent bladder catheterization (IBC) after urethral dilation, is an effective strategy in reducing stricture recurrence among the females. Clinical Trials Number: ID NCT06064968.

Vaccination against high-risk HPV types is a key preventive measure. However, concerns regarding vaccine safety may hinder vaccination efforts. This study aims to evaluate adverse events (AEs) reported in the Vaccine Adverse Event Reporting System (VAERS) following HPV vaccination from 2006 to 2024, providing insights into its safety profile. We analyzed VAERS data, a spontaneous reporting system containing de-identified AE reports. Four disproportionality analyses (ROR, PRR, BCPNN, and MGPS) were applied, and adverse event signals were defined only when the positive criteria were simultaneously met across all four methods. Statistical analyses were performed using R software and Microsoft Excel, with a significance threshold of p&#x2009;<&#x2009;0.05. A total of 77,909 HPV vaccine-related AE reports were analyzed, with 68.4% involving females and 48.7% affecting individuals under 18. Serious AEs accounted for 11,659 reports, with headache and fatigue being the most common. Syncope was the most frequent signal, while postural orthostatic tachycardia syndrome (POTS) exhibited the strongest signal strength. Approximately 90% of AEs occurred within 30 days post-vaccination. Among vaccine types, HPV4 had the highest number of reports, and intramuscular injection was the most common administration route. This study offers an updated pharmacovigilance assessment of adverse events reported following HPV vaccination, highlighting reported patterns and statistical signals that may warrant further investigation.

We report a case of normolipidemic lipoprotein glomerulopathy (LPG)&#xa0;associated with the APOE Kyoto variant. A 54-year-old Chinese man was referred for evaluation of persistent low-level proteinuria detected on routine screening, with preserved renal function and no clinical features of nephrotic syndrome. Laboratory evaluation showed proteinuria without overt dyslipidemia. Extensive evaluation excluded secondary causes. Renal biopsy revealed markedly dilated capillary loops filled with characteristic lipoprotein thrombi, consistent with LPG. Subsequent genetic testing identified a heterozygous APOE c.127C>T (p.Arg43Cys) mutation, consistent with the APOE Kyoto variant. Because fasting lipid levels remained within reference ranges, lipid-lowering therapy was not initiated. Angiotensin receptor blockade was associated with a reduction in urine protein-to-creatinine ratio from 0.38 to 0.28&#xa0;g/g over 2 months. This case broadens the phenotypic spectrum of APOE Kyoto-associated LPG by demonstrating biopsy-proven disease in the setting of largely normal systemic lipid levels.

Therapies using immune checkpoint inhibitors (ICI) are standard of care in metastatic renal cell carcinoma (mRCC). Currently, no accepted standardized biomarkers are available to predict treatment response in mRCC. We aimed to identify the predictive value of immunomodulatory markers interacting within the tumor microenvironment. We included 45 untreated and pretreated patients treated with ICI, divided by their progression free survival (PFS) into groups of good (> 18 months), intermediate (6-18 months) or poor treatment response (< 6 months). Tumor specimens were stained immunohistochemically for 28 markers and analysed by application of digital tissue microarrays using the open source software QuPath. The phagocytosis checkpoint molecule CD47 significantly predicted and higher CD20 (B cell density) was significantly correlated with longer PFS. CD20 was associated with tumor-infiltrating immune cells and checkpoint molecules. Tissue based quantification of CD47 and CD20 might be used to predict response to ICI in mRCC. Both markers influence the anti-tumor response and seem to be markers of a highly immune-infiltrated, and simultaneously functional immunosuppressed TME which seem to profit the most from ICI. Therefore, CD47 and CD20 could be suitable to discriminate between patients which profit from those who would not profit from ICI and avoid unnecessary costs due to side effects.

Retroperitoneal laparoscopic resection is the preferred minimally invasive surgery for adrenal tumors. Patients vary greatly in postoperative drain output, but no clear criteria exist to select candidates for a drainage-free strategy. The objective of the present study was to establish clinical screening criteria for identifying patients eligible for a drainage-free strategy after retroperitoneal laparoscopic adrenal tumor resection and verify the clinical value of the criteria. A retrospective analysis was first conducted on 126 patients who underwent the aforementioned surgery. Patients were divided into two groups based on total postoperative drain output: The drainage-free group (&#x2264;60 ml, 40 cases) and the drain group (>60 ml, 86 cases). Indicators such as age and tumor diameter were compared with identify factors influencing postoperative drain output. Subsequently, a prospective validation study was carried out involving 54 patients, with 20 patients meeting the preliminary screening criteria assigned to the experimental group and 34 ineligible patients to the control group. Perioperative data and complication rates of the two groups were compared. The retrospective univariate analysis identified seven indicators (including age and tumor diameter) associated with postoperative drain output (P<0.05). Multivariate logistic regression confirmed five independent risk factors for postoperative drain output: Age [odds ratio (OR)=1.062; 95% confidence interval (CI) 1.005-1.123; P=0.033], tumor diameter (OR=2.199; 95% CI: 1.162-4.159; P=0.015), locking clip application for adrenal tissue or central vein (OR=12.081; 95% CI: 1.772-82.385; P=0.011), saponification and adhesion of adipose tissue in the surgical area (OR=0.092; 95% CI: 0.026-0.319; P<0.001) and intraoperative blood loss (OR=10.48; 95% CI: 1.025-1.072; P<0.001). In the prospective validation study, only one patient in the experimental group had postoperative drain output >60 ml (recovered with conservative treatment). The experimental group also had significantly less total drain output, shorter drain removal time and shorter hospital discharge time than the control group (P<0.05), with no significant difference in complication rates (P>0.05). In conclusion, the established screening criteria may accurately identify eligible patients. This strategy appears to safely shorten hospital stays and facilitate stratified management and may have clinical value.

Bladder cancer represents a common malignant neoplasm of the genitourinary system, featuring an elevated recurrence rate and unfavorable prognosis, whereas the intrinsic mechanisms driving its malignant progression have not yet been fully clarified. In this study, we integrated single-cell transcriptome data from GSE222315 (5 bladder cancer samples and 4 adjacent normal samples) with bulk transcriptome data from the TCGA-BLCA cohort (409 tumor samples and 19 control samples) to investigate the impact of steroid metabolism on bladder cancer progression and the tumor stemness. Single-cell RNA sequencing analysis showed that steroid metabolism pathway genes were up-regulated in cancer cells. Also, the eminent steroid metabolism group exhibited stronger intensity and a greater number of intercellular interactions relative to the cohort characterized by diminished steroid metabolic capacity; additionally, tumor cells with high steroid metabolism showed elevated expression of stemness-related genes and diminished immune activity. Validation using bulk transcriptome data demonstrated that the steroid metabolism pathway was the most significantly enriched metabolic pathway in tumor tissues, and its core upregulated genes were negatively correlated with immune cell infiltration. Built upon differentially expressed genes including ACTC1 and CST1, the developed prognostic model showed superior predictive capability, with AUC scores over 0.77. Meanwhile, genes such as C7, DES, MYH11, and OGN were determined to be associated with unfavorable prognostic profiles in patients. And high-risk patients with poor prognosis outcomes in the survival model highly expressed steroid related genes like DHCR and SQLE. In conclusion, steroid metabolic reprogramming can reshape the TIME and is associated with bladder cancer progression, and reversing aberrant steroid metabolism has the potential to serve as a novel therapeutic regimen for bladder cancer.

Broad demographic representation is important in population-based research to enhance generalizability. The purpose of this manuscript is to describe strategies used to promote broad representation in the RISE FOR HEALTH study (RISE), consistent with its prioritized representation goals; and to compare participants to American women to gauge the success of these strategies. RISE was a large population-based cohort study of community-dwelling women selected by probability sampling of adult female residents of 57 geographically dispersed U.S. counties. Participation entailed completing self-administered surveys and an optional in-person assessment. Diversity goals and associated strategies were to: 1) ensure representation by race, ethnicity, and age similar to the U.S. population (by stratified probability sampling from a large marketing database); 2) remove barriers to participation by preferred Spanish language speakers (cultural adaptation, linguistic translation, bilingual mailings); and 3) promote diversity more broadly (marketing-style materials, community engagement). In 2024-2025, participant characteristics were compared to those of American women, using data from two national surveys (American Community Survey, National Health and Nutrition Examination Survey). 3,400 participants (of 50,367 invited) completed the baseline survey from 2022-2023 and were eligible. Consistent with the stratified sampling plan, participants were similar to the U.S. population with respect to race, ethnicity, and age. In contrast, they differed by Spanish as a primary language spoken (4.4% versus 12.9% in the U.S.) and completion of a high school degree or less (13.8% versus 35.9%). Strategies designed to promote diversity were variably successful in RISE, offering insight for future population-based research.

This study aimed to evaluate the efficacy of robot-assisted reconstruction using end-to-side ureteroureterostomy (UU) and Lich&#x2012;Gregoir ureterovesical reimplantation (UR) for complicated duplex kidneys in children. A retrospective study was conducted on pediatric patients who underwent combined robotic UU and Lich&#x2012;Gregoir UR between January 1, 2021, and January 1, 2024. The inclusion criterion was the presence of concurrent upper- and lower-pole ureteral pathologies. Surgical time, postoperative length of stay, pre- and postoperative anteroposterior diameter of the renal pelvis (APD), ureteral diameter (UD), renal function (RF) of the affected kidney, and complications were analyzed. In total, 12 patients presented with urinary tract infections (UTI, n&#x2009;=&#x2009;9), incontinence (n&#x2009;=&#x2009;2), and abdominal pain (n&#x2009;=&#x2009;1). Upper-pole pathologies included ectopic ureters (10 cases) and ureteroceles (2 cases). Lower-pole pathologies comprised ureteral stricture (n&#x2009;=&#x2009;4) and vesicoureteral reflux (VUR, n&#x2009;=&#x2009;8). The median surgical time was 177.5 minutes (range: 140-205 minutes), and the median hospital stay was 5 days (range: 3-7 days). Postoperative complications included two cases of UTI, both managed conservatively. At a median follow-up of 19 months (range: 12-31 months), no anastomotic stricture, urinary leakage, or ureteral stump syndrome occurred. Postoperative voiding cystourethrogram (VCUG) revealed no VUR in any patient. Pre- and postoperative APD (22.92&#x2009;&#xb1;&#x2009;9.07 mm vs. 7.33&#x2009;&#xb1;&#x2009;5.03 mm, p&#x2009;<&#x2009;0.001) and UD (11.08&#x2009;&#xb1;&#x2009;3.15 vs. 5.83&#x2009;&#xb1;&#x2009;2.41 mm, p&#x2009;<&#x2009;0.001) differed significantly in the upper pole system, as did the lower pole APD (14.00&#x2009;&#xb1;&#x2009;6.25 vs. 5.25&#x2009;&#xb1;&#x2009;3.02 mm, p&#x2009;<&#x2009;0.001) and UD (7.75&#x2009;&#xb1;&#x2009;2.26 vs. 4.75&#x2009;&#xb1;&#x2009;1.36 mm, p&#x2009;=&#x2009;0.003). The RF of the affected moiety improved significantly (36.58&#x2009;&#xb1;&#x2009;4.66% vs. 42.75%&#x2009;&#xb1;&#x2009;3.10%, p&#x2009;<&#x2009;0.001). Robot-assisted reconstruction using UU and Lich-Gregoir UR is a safe and effective approach for complex duplex kidneys requiring concurrent upper- and lower-tract reconstruction, demonstrating durable resolution of obstruction and reflux as well as functional preservation.

Prostate adenocarcinoma (PRAD) is one of the cancers that threaten the health of male, but its progression mechanism remains unclear. Golgi phosphoprotein 3 (GOLPH3) is aberrantly expressed in many cancers, but its role in PRAD progression remains unknown. This paper aims to study the function of GOLPH3 in PRAD. The online database was used to analyze the expression level of GOLPH3 transcriptome, and the expression level of GOLPH3 protein in PRAD tissues and cells was detected by western blotting. PC-3 and LNCaP cells were selected to construct the GOLPH3 overexpression PRAD cells. CCK8 assay, EdU staining, colony formation assay, and a nude mouse xenograft model were used to evaluate the proliferation of PRAD cells. Glucose metabolism activity was determined by lactate release, intracellular glucose level, oxygen consumption rate (OCR) and extracellular acidification rate (ECAR). Online public database analysis showed that the expression level of GOLPH3 transcriptome in tumor tissues was significantly higher than that in normal tissues of PRAD patients. And western blotting analysis suggested that GOLPH3 protein expression was elevated in PRAD tissues and cells. Results of CCK8 assay, EdU staining, colony formation assay and nude mouse xenograft analysis showed that GOLPH3 overexpression strongly promoted PRAD cell proliferation in vitro and in vivo. Importantly, GOLPH3 overexpression significantly increased the levels of lactate release and intracellular glucose levels by PRAD cells, and increased glucose metabolism-related enzyme activity, including HK, GPI, PGK, LDHA, and G6PD. Mechanistically, GOLPH3 overexpression markedly increased the p-AKT/AKT and p-mTOR/mTOR ratios, and LY294002 reduced cell proliferation and glucose metabolism levels elevated by GOLPH3 overexpression. GOLPH3, which is overexpressed in PRAD, may enhance glucose metabolic activity in PRAD cells in association with activation of the PI3K/AKT/mTOR pathway, thereby supporting PRAD cell proliferation. These findings provide basic mechanistic evidence for the role of GOLPH3 in PRAD cell metabolism, but further clinical studies are required to determine its prognostic or therapeutic relevance.

Penile prostheses have revolutionized the treatment of erectile dysfunction in men over the past 50 years, with implant infections remaining the most serious complication. Over the last 15 years, however, infection rates have declined substantially. This improvement is attributable to technological advances in implant design, particularly infection-retardant coatings, improved perioperative prophylactic concepts, and optimized patient selection based on identified risk factors. Modern surgical strategies such as the no-touch technique, tailored antibiotic and antifungal prophylactic regimens, and antiseptic irrigation protocols during revision procedures have contributed substantially to the reduction of postoperative infections. At the same time, the management of manifest implant infections has evolved: emergency explantations are now largely reserved for severe systemic infections, whereas targeted antimicrobial therapies followed by salvage surgery are increasingly being adopted. These developments enable a sustained reduction in infection-related complications associated with penile prosthesis implantation. Penisprothesen haben in den letzten 50 Jahren die Behandlung der erektilen Dysfunktion bei M&#xe4;nnern revolutioniert, wobei Protheseninfektionen weiterhin die schwerwiegendste Komplikation darstellen. In den vergangenen 15 Jahren ist die Infektionsrate jedoch deutlich gesunken. Verantwortlich hierf&#xfc;r sind technologische Fortschritte der Implantate, insbesondere infektionshemmende Beschichtungen, verbesserte perioperative Prophylaxekonzepte sowie eine optimierte Patientenselektion auf Basis identifizierter Risikofaktoren. Moderne chirurgische Strategien wie die no-touch Technik, angepasste antibiotische und antimykotische Prophylaxeregime sowie antiseptische Sp&#xfc;lprotokolle bei Revisionseingriffen tragen wesentlich zur Reduktion postoperativer Infektionen bei. Parallel hat sich das Management manifester Protheseninfektionen gewandelt: Notfallm&#xe4;&#xdf;ige Explantationen sind heute &#xfc;berwiegend schweren systemischen Infektionen vorbehalten, w&#xe4;hrend kalkulierte antimikrobielle Therapien mit anschlie&#xdf;ender Salvage-Operation zunehmend Anwendung finden. Diese Entwicklungen erm&#xf6;glichen eine nachhaltige Senkung infektionsbedingter Komplikationen bei Schwellk&#xf6;rperimplantationen.

Per- and polyfluoroalkyl substances (PFAS), persistent environmental contaminants, are associated with increased Prostate cancer (PCa) risk. However, their molecular mechanisms are poorly defined. We employed a comprehensive computational and experimental framework. The toxicological profiles of PFOA and PFOS were predicted. Shared molecular targets between PFAS and PCa were identified by integrating toxicogenomic and transcriptomic data, followed by protein-protein interaction network and enrichment analyses. A robust prognostic model was built and validated using multiple machine-learning algorithms. Core targets were further investigated via single-cell/spatial transcriptomics and molecular docking. Key findings were functionally validated in DU145 PCa cells using qPCR, Western blotting, and assays for proliferation, migration, and invasion. Computational analysis confirmed the carcinogenic and endocrine-disrupting potential of PFAS. We identified 219 common targets significantly enriched in inflammation, oxidative stress, and cancer-related pathways like PPAR and p53 signaling. Network topology highlighted key hub genes, including ALB and PPARG. A 10-gene machine-learning model demonstrated strong prognostic performance (average C-index: 0.710). Cross-omics analyses pinpointed CDC20 as a pivotal core gene within the PFAS-PCa network. Molecular docking indicated stable binding of PFAS to core targets like CDC20. In vitro experiments confirmed that PFAS exposure upregulates CDC20 and enhances the malignant phenotypes of PCa cells. Furthermore, docking suggested several natural compounds (e.g., quercetin) could potentially bind CDC20 to mitigate PFAS effects. This work systematically reveals that PFAS exposure is associated with PCa progression, potentially involving dysregulation of core genes such as CDC20 and perturbing critical cancer pathways. The developed prognostic model holds clinical relevance, and the identified natural products offer a foundation for designing interventions to potentially mitigate PFAS-associated carcinogenic effects, advancing both mechanistic understanding and preventive strategies. However, the findings are primarily based on computational predictions and a single cell line; further validation in multiple models and experimental systems is required.

Women have historically been underrepresented in leadership positions and academia in cardiothoracic surgery, creating barriers to career advancement and limiting role models for trainees. While publications are used to measure success in academia, invited articles such as editorials often represent a formal recognition of expertise. The objective of this study was to identify trends in the gender of editorial authors published in cardiothoracic surgery journals. Editorials published between 2018 and 2022 across 16 peer-reviewed cardiothoracic surgery journals were analyzed. Author gender was estimated using a validated tool (https://gender-api.com/) with additional verification using available institutional profiles. In total, 806 editorials were published with a total of 1,858 authors (293 women, 16%). Women authors were predominantly from the United States of America (45%) followed by India (9%) and Germany (8%). The percentage of women first authors increased between 2018 and 2022 (P < 0.001); 9% in 2018, 9% in 2019, 17% in 2020, 16% in 2021, and 23% in 2022. A similar trend was observed for women senior authorship (P < 0.0001) (6% in 2018, 9% in 2019, 14% in 2020, 15% in 2021, and 18% in 2022) as well as for editorials with all-women authorship (P < 0.0001), increasing steadily from 9% in 2018 to 20% in 2022. Women authorship in editorials published in cardiothoracic surgery journals has steadily increased in recent years. Despite progress, women still make up less than a quarter of first and senior authors, highlighting a critical gap in gender equity in academic leadership that must be urgently addressed.

Duplication of the kidney and ureter is a relatively rare congenital malformation compared with other systemic malformations. It is even rarer for the duplicate to have stones inside; therefore, the present study reports the case of a patient with complete repetitive ureteral malformations combined with occult stones who showed marked improvement in symptoms and good recovery after surgical treatment. The patient received a timely diagnosis and achieved a good treatment outcome. The patient was satisfied with the treatment and had a good follow-up. Early and accurate diagnosis and timely treatment are crucial for patients with recurrent ureteral malformations combined with occult stones, and can effectively improve patient prognosis.

Prostate cancer development and progression depend on androgen receptor (AR) signaling. Therefore, androgen-deprivation therapy (ADT) and AR signaling inhibitors (ARSIs) are standard therapies for advanced or metastatic disease. Although these treatments are initially effective, prostate cancer inevitably progresses to a lethal stage termed castration-resistant prostate cancer (CRPC). In the majority of patients, CRPC occurs via re-activation of AR signaling (CRPC-AR). However, lineage plasticity is a hallmark of cancer that drives AR-independent CRPC phenotypes in a subset of patients. One subtype of AR-negative CRPC is neuroendocrine prostate cancer (NEPC), which transforms from CRPC-AR by losing the characteristic AR-driven luminal epithelial identity and gaining neuroendocrine identity. Another AR-negative CRPC subtype lacks AR and neuroendocrine features and has therefore been classified as double-negative prostate cancer (DNPC). Chromatin modifications, alterations in three-dimensional (3D) genome structure, and expression of transcriptional regulators are crucial for controlling lineage states and modulating AR-dependent and AR-independent phenotypes in CRPC. Here, we highlight how high-resolution investigations of the 3D genome have revealed interdependence between chromatin architecture and transcriptional regulation, offering novel insights into the mechanisms of CRPC progression and context-specific targets for therapeutic intervention.

Pain and work-related musculoskeletal disorders are commonly seen in surgeons, significantly impacting quality of life and burnout. A questionnaire-based study was conducted to further investigate the nature and etiology of work-related pain among urologists in the state of Florida. This study aimed to quantify the number of urologists who reported work-related musculoskeletal disorders >25% of the time. The Florida Urologic Society Task Force developed a survey based on the Nordic Musculoskeletal Questionnaire, with additional input from Cornell's ergonomic studies. The Mayo Clinic Survey Research Center conducted the survey and distributed it to 504 members of the Florida Urologic Society in 2023. The total response rate was 18.6% (94/504). The primary outcome (number of urologists who reported pain >25% of the time) was 45.3% (34/75). In total, 32.4% (22/68) of the respondents reported pain associated with endoscopic surgery >25% of the time, 40.0% (14/35) reported pain for major open cases, 20.6% (13/63) reported pain for minor open cases, and 22.7% (5/22) reported pain for robotic cases. In total, 68.8% (53/77) of the respondents attributed their work-related pain to uncomfortable operating positions, and 29.9% (23/77) chose to ignore their pain. In this contemporaneous population of Florida urologic surgeons, almost half of the respondents describe having work-related pain >25% of the time. The data show that major open surgery had the highest rate of pain, followed closely by endoscopic surgery. Over 70% of the urologists in Florida are interested in official ergonomics training, which, if developed, may lead to increased productivity and better emotional, personal, and interpersonal well-being.