搜索结果：Urologia internationalis

To develop a preliminary, decision-making protocol capable of predicting sperm retrieval success in non-mosaic Klinefelter's syndrome (KS) patients. Main outcome measure was to identify predictors of successful sperm retrieval and to build a decision-making protocol capable of predicting this success by assessing several variables including age, testicular volume, and preoperative hormonal responses. A retrospective cohort study included all men with non-mosaic KS who were treated with recombinant hCG and then underwent microdissection testicular sperm extraction (micro-TESE) between December 2019 and March 2023. Thirty-eight patients who were treated medically with rec-hCG prior to their micro-TESE were included. Sperm was retrieved successfully from 28 (73.7%) patients. Initial testosterone differences between the groups were small and not significant, the mean pre-op (post-hormonal treatment) testosterone between the two groups was significant (p = 0.001). We then built a decision-making tree, in which testosterone change was the primary determining factor for successful sperm retrieval, testicular volume was a contributory secondary variable, and age was a tertiary consideration in cases of low testicular volume. Using this model, we observed the highest success rates (97%) in men with testosterone change of 9 nmol/L or more and testicular volume of 3 cc or more. on the other hand, men with no testosterone change with hormonal treatment, low testicular volume who were 25 years old or more had a success rate of only 63%. This study proposes a preliminary, decision-making protocol capable of predicting sperm retrieval success in non-mosaic KS patients. This model can be used as part of an individualized counseling approach. External validation is essential to corroborate our preliminary results.

Lymph node (LN) staging remains critical for risk stratification and treatment selection in intermediate-risk prostate cancer (IR-PCa). Conventional imaging modalities have limited sensitivity, and extended pelvic LN dissection (ePLND) is associated with considerable morbidity. This narrative review evaluates conventional imaging, molecular imaging, and intraoperative technologies for LN staging in IR-PCa. Conventional computed tomography and magnetic resonance imaging demonstrate low sensitivity for detecting LN metastasis. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography shows substantially improved diagnostic performance; however, it may still underestimate micrometastatic disease. Intraoperative approaches, including PSMA-targeted fluorescence imaging and sentinel LN biopsy, enable real-time detection and may reduce morbidity while maintaining high diagnostic accuracy in experienced centers. However, these techniques are limited by technical complexity, lack of standardized protocols, and restricted availability in routine clinical practice. A multimodal, risk-adapted strategy combining preoperative molecular imaging and intraoperative targeted techniques may improve the precision of LN staging. This integrated approach can help minimize unnecessary ePLND and reduce procedure-related morbidity in patients with IR-PCa.

The objectives of the study were to characterize microstructural and mechanical heterogeneity in calcium oxalate monohydrate renal calculi using high-resolution Vickers microhardness testing and to explore potential implications for laser lithotripsy outcomes. Five pure calcium oxalate monohydrate renal calculi from the same renal calyx were analyzed to ensure chemical equivalence. One stone per pair underwent routine analysis, and its intact companion stone was used for microhardness testing. Composition was confirmed by Fourier-transform infrared spectroscopy. Stones were embedded in epoxy resin, polished with diamond abrasives, hydrated for 24 h, and examined using high-resolution digital light microscopy. Vickers microhardness (HV0.2) was measured on predefined grids using standardized microindentation methodology. Stone diameters ranged from 1.5 to 3 mm. Vickers hardness varied widely (45-180 HV0.2), with mean per-stone values between 76.2 and 137.5 HV0.2. All stones exhibited alternating hard and soft regions without concentric or radial patterns. Calcium oxalate monohydrate renal calculi demonstrate pronounced, irregular microhardness variation. This heterogeneity may explain why some regions dust easily while others resist laser ablation and persist as fragments. Mechanical profiling may serve as a useful adjunct in planning endourological stone treatment.

Accurate assessment of muscularis propria invasion is critical for therapeutic decision-making in bladder cancer. The application of contrast-enhanced ultrasound (CEUS) in bladder cancer requires further validation. Using histopathology as the reference standard, we compared the diagnostic performance of CEUS and enhanced magnetic resonance imaging (E-MRI) in 190 patients who underwent transurethral resection of bladder tumor. The accuracy, sensitivity, and specificity of both modalities in determining malignancy and muscular invasion were analyzed. For diagnosing malignant tumors, the accuracy of CEUS and E-MRI was 83.87% and 80.64%, respectively. No significant differences were observed in sensitivity (85.71% vs. 84.28%) or specificity (78.26% vs. 69.56%) (p > 0.05). In assessing muscular invasion, CEUS demonstrated significantly higher specificity than E-MRI (95% vs. 77.5%, p = 0.039), while no significant difference was found in sensitivity (77.33% vs. 74.66%). CEUS exhibits superior specificity for evaluating muscular invasion in bladder urothelial carcinoma and can serve as a valuable complement to E-MRI for clinical staging.

In penile cancer, guideline-concordant invasive nodal staging in clinically node-negative (cN0) patients must balance diagnostic value against perioperative harm. We quantified early perioperative outcomes within a guideline-concordant nodal staging pathway, comparing primary dynamic sentinel node biopsy/sentinel lymph-node excision (DSNB/SLNE) with completion inguinal lymph-node dissection (ILND) performed after sentinel node positivity in a stage-restricted pT1b+ cohort. Single-center retrospective observational cohort study at a tertiary referral center, January 2013-December 2024. Of 127 screened patients undergoing any groin procedure, 98 had complete datasets; the primary analysis was restricted to pT1b+ disease (n = 61). Primary outcomes were 30-day major complications (Clavien-Dindo ≥III) and length of stay (LOS). Secondary outcomes were type-specific complications, unplanned readmission, and reoperation. Outcomes were captured per procedure using distinct 30-day windows. Paired within-patient analyses used exact McNemar and Wilcoxon signed-rank tests; unpaired sensitivity analyses used Fisher's exact and Welch's t tests. In the pT1b+ cohort, 61 patients underwent primary SLNE/DSNB, and 30 subsequently underwent completion ILND after sentinel node positivity. For perioperative analyses, procedures were evaluated at the procedure level (61 SLNE procedures; 30 completion ILND procedures). Major complications occurred in 4/61 (6.7%) after SLNE versus 8/30 (26.7%) after completion ILND (absolute difference 20.0 percentage points; Fisher's exact p = 0.0175). In paired analyses (n = 30), discordant events favored SLNE (matched OR 0.12, 95% CI 0.02-1.00; exact McNemar p = 0.039). LOS was longer after completion ILND; the paired median within-patient difference was +6 days (Wilcoxon p = 0.000238), and unpaired analyses showed a mean difference of approximately +8.68 days (Welch's t-test p = 0.00273). Completion ILND had higher 30-day rates of lymphocele, reoperation, readmission, infection, impaired wound healing, skin necrosis, and sepsis. In a guideline-aligned cN0, pT1b+ pathway, primary DSNB/SLNE was associated with substantially lower early perioperative burden than completion ILND after sentinel node positivity while identifying the subgroup requiring therapeutic escalation. These findings quantify the additional morbidity associated with escalation after positive sentinel staging rather than a head-to-head comparison of equivalent primary strategies.

Chronic prostatitis/chronic pelvic pain syndrome CP/CPPS is a relatively common disease and shows an association with urogenital infections. Tuft cells in general have been identified at various entry points into the body (respiratory tract, gastrointestinal tract, and urogenital tract) and are seen as guardians against invading threats. Urethral tuft cells utilizing canonical taste transduction cascade to detect of microbial products and initiating reflex micturition and neurogenic inflammation as a protective mechanism in response. Impaired chemoreception of the T2R38 taste receptor predisposes individuals to upper respiratory tract infections. Therefore, it is very likely that impaired chemoreception has a comparable effect on bacterial urogenital infections, whereas non-bacterial urogenital infections should remain unaffected. The aim of this study was to investigate the influence of TAS2R38 receptor functionality, as measured by a taste test, on the clinical presentation of patients with chronic abacterial prostatitis type III. From 2016 to 2025 a total of 252 patients with diagnosed CP/CPPS received a comprehensive andrological work-up including a taste test for the functionality of the TAS2R38 receptor. Complete semen analysis was performed according to WHO 2021 recommendations including the determination of inflammatory parameters in the ejaculate as well as microbiological examination of first-void urine, post-prostate massage urine and ejaculate. The proportion of tasters was 55.95%, while non-tasters accounted for 44.05%. No significant differences could be found between tasters and non-tasters with CP/CPPS with regard to symptom burden measured using questionnaires, various ejaculate parameters, prostate-specific antigen, and microbiological results. Only seminal elastase and serum CRP levels showed a significant difference, but with higher values in the taster group, which, in view of our initial hypothesis, is more likely a statistical coincidence. The results of our studies show that the taste status of TAS2R38 in patients with chronic abacterial prostatitis type III had no association with symptom severity, the ejaculate parameters examined, or the serum levels of PSA and CRP.

This study aimed to evaluate the harms and oncological benefits of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) in prostate cancer patients at risk for regional lymph node invasion. Patients with cN0M0 prostate cancer who underwent RP between January 2013 and February 2023 were included. Patients were categorized into two groups: 334 patients who underwent RP with PLND (group A) and 161 without PLND (group B). Perioperative and oncologic outcomes were assessed, and multivariate analysis identified independent prognostic factors. Inverse probability of treatment weighting (IPTW) was applied to account for baseline differences. Group A had more advanced disease, longer operation times, and higher complication rates, with 58.3% of complications related to PLND. After a median follow-up of 56 months, there were no significant differences in 4-year biochemical recurrence-free survival (BRFS) (68.9% vs. 75.4%), metastasis-free survival, or overall survival between the groups. Positive surgical margins and tumor grade were independent risk factors for biochemical recurrence, while PLND was not. Cox regression in the IPTW-adjusted cohort confirmed no significant impact of PLND on BRFS (HR: 0.70, p = 0.09). PLND during RP increases postoperative complications without improving short-term oncologic outcomes, serving mainly as a staging procedure to inform management.

The effect of insulin-dependence in type 2 diabetes mellitus (T2DM) on adverse in-hospital outcomes after nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) is unknown. Descriptive statistics, propensity score matching (PSM), and multivariable regression models were applied to the National Inpatient Sample (2004-2019) UTUC patients treated with NU. T2DM was stratified between insulin-dependent (ID) and non-insulin-dependent (NID) subtypes. In 10,761 NU patients, rates of ID-T2DM and NID-T2DM were 2.7% and 19.1%, respectively. During the study period, ID-T2DM rates increased from 0.1 to 4.2% (estimated annual percentage change [EAPC]: +11.8%, p<0.001), whereas NID-T2DM rates increased from 13.6 to 18.0% (EAPC: +1.1%, p=0.045). After PSM, ID-T2DM patients (294 vs. 588 non-diabetic controls) exhibited higher rates of blood transfusions (+4.9%) and genitourinary complications (+7.8%), as well as higher total hospital charges (THC; +9.3%). After multivariable adjustment, these increases translated into higher odds of blood transfusions (odds ratio [OR] 1.88, p=0.008) and genitourinary complications (OR 1.40, p=0.027), as well as higher total hospital charges (incidence rate ratio [IRR] 1.08, p<0.001). NID-T2DM patients (2,051 vs. 4,102 non-diabetic controls) exhibited smaller increases in blood transfusions (+2.5%) and THC (+5.3%), corresponding to OR 1.28 (p=0.002) and IRR 1.05 (p<0.001), respectively. Although ID-T2DM represents a relatively small subgroup, its rates increased over time. ID-T2DM was associated with higher rates of blood transfusions, genitourinary complications, and increased THC after NU. These findings suggest that ID-T2DM patients undergoing NU may represent a potential target population for perioperative optimization to reduce surgical morbidity and resource utilization.

Sex-based differences in enrollment rates in clinical trials and in cancer outcomes are evident. Real-world (RW) results might differ from phase II/III trials. The aim was to compare sex-specific outcomes of RW studies and randomized controlled trials (RCT) in locally advanced or metastasized renal cell cancer (la/mRCC). A systematic search in EMBASE, PubMed, MEDLINE, and Scopus on systemic therapies for la/mRCC was performed. Phase II/III trials, RCT, non-interventional prospective studies, retrospective studies, or case series were included. Data on overall survival (OS) and PFS (DFS for adjuvant therapies), enrollment rates, and adverse events were retrieved. Seventy studies were included. Females were underrepresented in RCTs. Some RW analyses exceeded the epidemiological benchmark. Outcome analyses exclusively revealed advantages for males: better OS/PFS for cabozantinib (RW), better OS for nivolumab (CheckMate 025), better PFS for tivozanib (TIVO-3), better PFS for nivolumab + ipilimumab (RW), better OS for nivolumab + cabozantinib (CheckMate 9ER), better DFS for adjuvant pembrolizumab (Keynote-564). No sex-specific toxicity analyses were published in RW studies or RCT. This systematic review enlightens sex-specific gaps in enrollment and cancer outcome, as well as the lack of sex-specific toxicity analyses. Balanced enrollment rates and reporting of sex-specific toxicity should be obligatory in evaluations of la/mRCC treatments.

To investigate the feasibility of mini-percutaneous nephrolithotomy (mPCNL) with gravity-assisted low-pressure irrigation in managing renal pelvic stones complicated by multiple calyceal pyonephrosis (characterized by the "cat's paw sign" on CT scan) as an alternative to multiple percutaneous drainage. A retrospective analysis was conducted on 7 patients (4 males, 3 females; mean age 52.1 years) who underwent one-stage mPCNL between 2019 and 2023. Meticulous preoperative antibiotic prophylaxis was administered, and intraoperative perfusion pressure was maintained below 100 cm H2O using gravity irrigation. All operations were completed successfully without major complications (Clavien-Dindo grade >2). Two patients experienced transient fever, which resolved with targeted treatment. Key outcomes included stable preoperative hemoglobin levels (mean: 107.86 g/L) and manageable postoperative inflammatory markers (CRP: 35.54 mg/L at 12 h postoperatively). mPCNL combined with gravity-assisted low-pressure irrigation is a practical alternative for resource-limited centers, enabling single-tract decompression of all obstructed calyces, immediate stone clearance, and acceptable complications. It is particularly suited for small renal pelves with obstructing stones, providing prompt relief of obstruction and infection while minimizing renal parenchymal damage. However, as a pilot study, the small sample size warrants further multicenter studies for validation.

This study compared the efficacy of three combined treatment regimens (biofeedback electrical stimulation [BES] combined with pelvic floor muscle training [PFMT], acupuncture combined with PFMT, and a triple therapy regimen of acupuncture, BES, and PFMT) in addressing urinary incontinence (UI) and sexual dysfunction in patients with postpartum pelvic floor dysfunction (PFD), with the aim of exploring the clinical advantages of the triple therapy regimen. This study was designed as a randomized controlled trial, with blinding applied to both the evaluators and the data analysts. A total of 203 postpartum women with PFD were enrolled and randomly assigned to Group A (BES+ PFMT, n = 65), Group B (acupuncture + PFMT, n = 68), and Group C (acupuncture + BES + PFMT, n = 64). Pelvic floor EMG, muscle strength, MUCP, and MFR were measured at baseline and 6 months post-treatment. Leakage volume was assessed by 1-hour pad test. UI was evaluated using ICI-Q-SF and IIQ-7, and sexual function using FSFI and PISQ-31. Adverse events were recorded throughout treatment. All groups showed significant improvement in EMG, muscle strength, MUCP, MFR, FSFI, and PISQ-31 scores, alongside reductions in leakage volume, ICI-Q-SF, and IIQ-7 scores. Improvements were most significant in Group C. No significant difference was found between Groups A and B after treatment. Adverse event rates did not differ significantly among groups. Compared to dual-therapy approaches, triple-therapy (acupuncture + BES + PFMT) enhances postpartum pelvic floor rehabilitation, effectively improving UI and sexual function in patients with PFD.

Active surveillance (AS) is the guideline-recommended management strategy for low-risk and favorable intermediate-risk prostate cancer (PCa). However, conventional risk stratification remains limited in predictive accuracy. Robust real-world evidence on the clinical utility of the Cell Cycle Risk (CCR; Prolaris&#xae;) score within European healthcare settings is currently scarce. We performed a retrospective single-center study of 60 localized PCa patients who underwent CCR testing at a tertiary academic urologic center between 2021 and 2025. We analyzed indications for testing, CCR treatment recommendations, and adherence rates using descriptive statistics. Median patient age was 62 years, median PSA level was 5.76 ng/ml. Overall, 13.3% of biopsy cores were positive, and 93.3% of patients had a Gleason score (GS) of 6. CCR testing was performed after initial diagnosis in 61.7% of patients and during ongoing AS in 38.3%. Following CCR testing, definitive therapy was recommended in 21.7% of patients, with an adherence rate of 53.8%, whereas continued AS was recommended in 78.3% of patients, with an adherence rate of 87.2%. CCR testing demonstrated high adherence rates, particularly for AS recommendations in the real-world setting. These findings support Prolaris&#xae; as a complementary decision aid for AS patient selection and management.

Persistent lower urinary tract symptoms (LUTSs) in young adults following childhood primary nocturnal enuresis (PNE) refractory to desmopressin represent an undercharacterized condition at the pediatric-adult care interface. No prior study has compared pharmacotherapy options in this specific population. We performed a retrospective, single-center, hypothesis-generating comparative cohort study at a tertiary urology center (January 2017-September 2025). Male adults aged 18-35 years with documented childhood PNE based on International Children's Continence Society (ICCS) criteria, desmopressin treatment failure, and persistent storage-phase LUTSs were included. Patients received mirabegron 25-50 mg daily (group A, n = 33) or anticholinergic therapy (group B, n = 32). The primary outcome was categorical treatment response (complete &#x2265;75%, partial 50-74%, minimal 25-49%, failure <25%). Secondary outcomes included nocturia, urgency, micturition frequency, incontinence episodes, International Prostate Symptom Score (IPSS), quality of life, and adverse events. Analyses used independent t tests, chi-square/Fisher exact tests, paired t tests, and analysis of covariance. Baseline characteristics were comparable between groups. Childhood nonmonosymptomatic enuresis phenotype was prevalent in 86.2% of patients, with reduced functional bladder capacity documented in 86.2%. Mirabegron achieved higher overall clinical benefit (&#x2265;50% improvement) than anticholinergics (78.8% vs. 56.3%, p = 0.042) and higher complete response rates (24.2% vs. 6.3%, p = 0.044). Symptom reductions consistently favored mirabegron: nocturia 51% vs. 38% (p = 0.031), urgency 48% vs. 36% (p = 0.024), micturition frequency 37% vs. 26% (p = 0.018), and quality of life improvement 58% vs. 38% (p = 0.009). Safety profiles were comparable with no serious adverse events and similar treatment persistence (90.9% vs. 87.5%, p = 0.642). Pending prospective confirmation, mirabegron provides superior efficacy with comparable safety versus anticholinergic therapy in male adults with persistent LUTS after desmopressin-refractory childhood PNE, supporting &#x3b2;3-adrenergic agonist therapy as a promising option for this underserved transitional population.

Degarelix and relugolix are two GnRH antagonists approved by the FDA for androgen deprivation therapy in the treatment of prostate cancer. However, differences in their safety profiles and the characteristics of specific adverse events (AEs) remain insufficiently characterized. This study analyzes AEs associated with degarelix and relugolix reported in the FAERS from Q1 2009 through Q2 2024. Multiple signal detection methods, including reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and empirical Bayes geometric mean, were employed to assess drug-AE associations. A total of 3,357 AE reports associated with degarelix and 4,075 reports related to relugolix were retrieved from the FAERS database. Signal analysis revealed that the most common AEs associated with degarelix were injection site reactions, whereas relugolix was frequently associated with hot flushes. Furthermore, the study identified several rare AEs not included in the drug labeling. This study identified common AEs associated with degarelix and relugolix but also identified several potential safety signals. These findings provide additional pharmacovigilance evidence for post-marketing safety monitoring and highlight potential safety signals that warrant further clinical and epidemiological investigation.

Advanced reasoning large language models are increasingly being explored for clinical decision support, but evidence regarding their performance in urology-specific tasks and their comparative standing against human respondents remains limited. This study compared five advanced reasoning models on urology-related multiple-choice questions from the MedQA dataset and benchmarked their performance against medical students and experienced urologists in terms of accuracy, response efficiency, and agreement patterns. We extracted 434 urology-relevant items and evaluated five models - DeepSeek-R1, ChatGPT O4-mini, Gemini 2.5 Pro, Claude 3.7 Sonnet, and Grok 3 - using a standardized prompt. Accuracy was computed against reference answers; API response times and connection failures were recorded. In addition, 20 senior medical students and 20 experienced urologists answered subsets of the same item bank using a balanced block design; group-level majority-vote answers were used as human baselines. Statistical analyses included Cochran's Q and McNemar tests (artificial intelligence [AI]-only accuracy), a logistic generalized linear mixed-effects model with urologists as the reference (model-adjusted accuracy), Fleiss' kappa and Cohen's kappa (agreement), and Friedman and Wilcoxon signed-rank tests (response time). Across the AI-only comparison, all models achieved high accuracy (86.9-93.3%), with DeepSeek-R1, ChatGPT O4-mini, and Gemini 2.5 Pro outperforming Claude 3.7 Sonnet and Grok 3. In the model-adjusted analysis, all five AI models showed significantly higher odds of correct answers than experienced urologists (all p < 0.001, Dunnett-adjusted), while medical students did not differ significantly from urologists. ChatGPT O4-mini had the shortest median API response time (5.03 s), whereas group-level median task completion times were 15.87 s for students and 17.57 s for urologists; Grok 3 was the slowest among AI models (27.62 s). Connection failure rates were 0% for ChatGPT O4-mini, Gemini 2.5 Pro, and Claude 3.7 Sonnet; 1.6% for DeepSeek-R1; and 2.8% for Grok 3. Agreement across the five AI models and the two human majority-vote baselines was moderate-to-substantial (Fleiss' &#x3ba; = 0.685, p < 0.001). Modern reasoning models achieve strong accuracy and efficiency on urology-focused benchmark questions, supporting their potential role as useful clinical assistants when implemented with appropriate human oversight. ChatGPT O4-mini's rapid latency further underscores its suitability for time-sensitive workflows, while model-adjusted analyses indicate its consistently superior accuracy relative to experienced urologists within this standardized assessment format.

Perioperative and peri-interventional antibiotic prophylaxis remains fundamental to infection prevention in surgical and interventional urology, yet its overuse and unjustified prolongation continue to drive antimicrobial resistance and expose patients to avoidable harm. The newly finalized German interdisciplinary AWMF S3 clinical practice guideline establishes an evidence-based, risk-adapted, and stewardship-oriented framework that redefines antibiotic prophylaxis as a rigorously justified and time-limited intervention. This manuscript distills the urology-specific recommendations and contrasts them with the 2025 EAU guidelines on urological infections, emphasizing alignment, procedural nuance, and practical relevance. The AWMF S3 framework mandates strict indication, intravenous administration 30-60 min before incision, single-dose prophylaxis for most clean and clean-contaminated procedures, and redosing only when pharmacokinetically warranted, with discontinuation at wound closure as a universal standard. Within urology, resistance-adapted prophylaxis with rectal antisepsis is recommended for transrectal prostate biopsy, whereas transperineal biopsy may be safely performed without antibiotics in low-risk patients with sterile urine and proper antisepsis. Prophylaxis confers no consistent benefit for ureterorenoscopy or cystoscopy in sterile urine but remains indicated for percutaneous nephrolithotomy, transurethral resection of the prostate, and major open or laparoscopic procedures such as radical prostatectomy and cystectomy, where broad-spectrum single-dose coverage with intraoperative redosing may be required in prolonged surgery. Across all procedures, the AWMF S3 and EAU 2025 recommendations show high concordance, differing primarily in granularity and evidence grading. A risk-adapted, single-dose strategy unites patient safety with antimicrobial stewardship and positions urology as a model discipline for rational, quality-assured infection prevention in modern surgery.

This study aims to compare the safety and efficacy of the pressure-controlling ureteral access sheath (PCUAS) and the tip-flexible suctioning ureteral access sheath (FSUAS) for treating renal stones &#x2264;3 cm. A total of 292 patients with renal stones were prospectively enrolled across three centers from June 2022 to October 2024. Participants were randomized into PCUAS and FSUAS groups in a 1:1 ratio. Data compared between groups included demographic information, position placement time, ureteroscopy time, sheath placement time, operation time, stone-free rate, postoperative hospitalization duration, intraoperative complications, and sheath placement success rate. There was no statistically significant difference in preoperative data between the two groups (P > 0.05). Of the 292 patients, ureteral access sheaths (UAS) placement was successful in 268 patients during the first stage, while 19 patients required a second stage after ureteral stent placement. Five patients were converted to percutaneous nephrolithotomy (PCNL) due to failed UAS placement. The PCUAS group had better fever and pain score outcomes than the FSUAS group (P < 0.05). Conversely, the FSUAS group had shorter position placement time, ureteroscopy time, and higher stone-free rate at 1 d and 1 month postoperatively (P < 0.05). The remaining indices showed no statistical significance between the groups. Both PCUAS and FSUAS have distinct advantages regarding safety and efficacy. Combining the benefits of both techniques could further improve the safety and effectiveness of flexible ureteroscopic lithotripsy for renal stones.

Tubulocystic renal cell carcinoma (TC-RCC) is a rare and distinct subtype of renal cell carcinoma with characteristic histopathological and immunohistochemical features. Due to its rarity, limited data exist regarding its clinicopathological profile, biological behavior, and prognosis. This review aims to analyze reported TC-RCC cases to improve understanding of tumor characteristics, outcomes, and key diagnostic markers. Scoping review of 30 published TC-RCC cases was conducted. Data collected included tumor laterality, site, size, focality, stage, associated malignancies, local extension, metastatic spread, lymph node involvement, vascular invasion, and immunohistochemical findings relevant to diagnosis and prognosis. TC-RCC demonstrated a left-sided predominance (63.3%) and was most often unifocal. The upper renal pole was the most commonly involved site (36.7%). Tumor size ranged from 0.8 to 37 cm. Concurrent malignancies were identified in 26.7% of cases, most frequently papillary renal cell carcinoma. Extra-renal extension and distant metastases occurred in 16.7% of cases, while lymphovascular invasion was uncommon. Immunohistochemistry showed frequent positivity for AMACR (66.7%), CD10 (46.7%), and Vimentin (43.3%). TC-RCC exhibits variable clinical behavior and a notable association with concurrent malignancies. Immunohistochemical markers, particularly AMACR and CD10, are diagnostically valuable. Further studies are needed to establish prognostic markers and standardized management strategies.

Chest computed tomography (CT) is commonly obtained for initial staging of testicular cancer. Since pulmonary metastases are rare in the absence of retroperitoneal disease or elevated tumor markers, a selective imaging approach may be justified, as routine chest CT can lead to unnecessary radiation exposure to the thorax. We conducted a retrospective cohort study of men evaluated for a newly diagnosed testicular mass at a tertiary medical center between 2011 and 2025. According to institutional protocol, all patients underwent abdominal and chest CT prior to radical orchiectomy. A risk-stratified approach was then assessed, assuming that chest CT would have been omitted if both serum tumor markers and abdominal CT were negative for metastasis. The primary outcome was the false-negative rate for thoracic metastases among patients who would have been triaged to omit chest CT, and the key secondary outcome was the proportion of chest CT examinations that could have been avoided. Among 183 eligible patients (mean age 34.3 &#xb1; 11.1 years), 174 (95.0%) had germ-cell tumors, including 107 (61.4%) seminomas. Chest metastases were identified in 10 patients (5.5%). Nine (90%) had positive tumor markers and seven (70%) had retroperitoneal nodal involvement. Using the prespecified rule (perform chest CT if either markers or retroperitoneal nodes were abnormal), no metastatic cases would have been missed, yielding sensitivity 100% (95% confidence interval [CI]: 69.2-100.0) and negative predictive value: 100.0% (95% CI: 95.7-100). Specificity was 48.0% (95% CI: 40.3-55.7), and application of the rule would have avoided 45.4% (95% CI: 38.0-52.9) of chest CTs. Integrating serum tumor markers with abdominal CT before deciding on chest CT may safely reduce radiation exposure without compromising diagnostic accuracy in the workup of men with a testicular mass. External validation is warranted before clinical implementation.