International Urology and Nephrology最新文献

{"title":"Methodological considerations on the safety and efficacy of adding voclosporin to standard treatment for lupus nephritis: a commentary.","authors":"Menglu Ni, Wenbo Hu, Linsong Gao, Yuying Mao","doi":"10.1007/s11255-026-05186-1","DOIUrl":"https://doi.org/10.1007/s11255-026-05186-1","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of monoplanar, cross-table bull's-eye, and a hybrid ultrasound-fluoroscopy technique for renal access in supine PCNL: a cognitive mapping approach.","authors":"Hüseyin Koçakgöl, Abdullah Turan, Muhammed Çağrı Akkuş, Mehmet Eren Öztürk, Deniz Öztürk Koçakgöl, Mehmet Sefa Altay, Muhittin Atar, İbrahim Karabulut","doi":"10.1007/s11255-026-05181-6","DOIUrl":"https://doi.org/10.1007/s11255-026-05181-6","url":null,"abstract":"<p><strong>Purpose: </strong>Percutaneous needle access is a critical step in percutaneous nephrolithotomy (PCNL). Supine PCNL, favored for its anesthetic and physiological benefits, can be performed using various puncture techniques. This study compared the efficacy and radiation safety of monoplanar, cross-table bull's-eye, and a combined ultrasound (US)-fluoroscopy-guided access technique for supine PCNL.</p><p><strong>Methods: </strong>Between January 2021 and March 2025, 130 patients undergoing supine PCNL were reviewed in three groups: monoplanar (Group A, n = 41), cross-table bull's-eye (Group B, n = 45), and combined US-fluoroscopy (Group C, n = 44). In Group C, pre-procedural US established a cognitive vectorial roadmap to determine needle trajectory and depth. Punctures were performed under 0° fluoroscopy, with on-demand refinements using 0-30° rotation and cephalad angulation for depth verification. Perioperative outcomes and radiation times were compared.</p><p><strong>Results: </strong>Total operative time, stone-free (SF) rates, complications, blood transfusion rates, creatinine (Cr) change, hemoglobin (Hb) loss, nephrostomy and hospital stay did not differ significantly among groups (p > 0.05). However, mean fluoroscopy time for successful puncture was significantly lower in the combined US-fluoroscopy group (26.59 s) compared to monoplanar (42.82 s) and cross-table bull's-eye (40.62 s) techniques (p < 0.001).</p><p><strong>Conclusion: </strong>The combined US-fluoroscopy-guided technique is feasible for supine PCNL and significantly reduces radiation exposure. By integrating US-derived cognitive planning with on-demand fluoroscopic verification, this hybrid approach facilitates efficient needle puncture without compromising procedural precision or clinical success. It serves as a valuable alternative for optimizing radiation safety in urologic practice.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of intraoperative tranexamic acid in transurethral resection of the prostate: a systematic review and meta-analysis of randomised-controlled trials.","authors":"Cian M Hehir, Gavin G Calpin, Gavin P Dowling, Gordon R Daly, Barry B McGuire","doi":"10.1007/s11255-026-05180-7","DOIUrl":"https://doi.org/10.1007/s11255-026-05180-7","url":null,"abstract":"<p><strong>Purpose: </strong>To critically appraise and evaluate the safety and efficacy of intraoperative tranexamic acid (TXA) administration during transurethral resection of the prostate (TURP).</p><p><strong>Methods: </strong>A systematic search of online databases was conducted to identify randomised-controlled trials (RCTs) which compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated with TXA (intervention) as compared to placebo/none (control). The efficacy of intraoperative TXA was evaluated through outcomes related to blood loss, rate of blood transfusion and operative time. The safety of TXA was evaluated through pooled analysis of both deep venous thrombosis and pulmonary emboli.</p><p><strong>Results: </strong>Nine RCTs met the inclusion criteria for this meta-analysis in which a total of 661 patients underwent TURP for BPH (331 TXA: 330 Control). There was significantly less intraoperative bleeding in the TXA group (MD -40.23 mL [95%CI -66.76 to -13.71], p = 0.003), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day (MD -0.55 g/dL [95%CI -0.71 to -0.39], p < 0.00001). TXA was associated with a significantly shorter operative time (MD -9.77 min [95%CI -16.97 to -2.58], p = 0.008), with patients who received TXA exposed to a significantly reduced risk of blood transfusion (0.99% TXA vs. 7.69% Control, OR 0.16 [95%CI 0.03-0.93], p = 0.04). There was no statistically significant increase in risk of DVT in the TXA group, p = 0.46.</p><p><strong>Conclusion: </strong>Intraoperative administration of TXA is safe and effective in reducing intraoperative blood loss, operative time and postoperative haemoglobin (Hb) drop with resultant decrease in blood transfusion requirements. This meta-analysis did not detect any significant increase in venous thrombosis or risk of pulmonary embolism incurred by TXA administration.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of clinical outcomes of cabozantinib plus nivolumab and lenvatinib plus pembrolizumab in patients with metastatic renal cell carcinoma.","authors":"Kazutaka Nakamura, Kazuhiko Yoshida, Yuki Kobari, Yuki Nemoto, Hiroki Ishihara, Hironori Fukuda, Junpei Iizuka, Hiroaki Shimmura, Hiroshi Kobayashi, Yasunobu Hashimoto, Tsunenori Kondo, Toshio Takagi","doi":"10.1007/s11255-026-05174-5","DOIUrl":"https://doi.org/10.1007/s11255-026-05174-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the treatment outcomes and safety of cabozantinib plus nivolumab (C + N) and lenvatinib plus pembrolizumab (L + P) for patients with metastatic renal cell carcinoma (mRCC).</p><p><strong>Methods: </strong>This multicenter retrospective analysis included 92 patients with mRCC treated with either C + N or L + P as first-line therapy between April 2018 and August 2024. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs) were compared. Multivariable analysis was performed to identify independent prognostic factors for PFS.</p><p><strong>Results: </strong>Fifty-three patients received C + N and 39 received L + P. PFS (24.1 months vs. not reached, P = 0.725) and OS (46.7 months vs. not reached, P = 0.912) were not significantly different between the C + N and L + P groups. Over a median follow-up duration of 13.9 months, 31 patients experienced disease progression and 12 died. ORR was higher in the C + N group than in the L + P group (79% vs. 49%, P = 0.002), whereas DCR (100% vs. 95%, P = 0.096) and grade ≥ 3 TRAEs (47% vs. 36%, P = 0.280) were comparable. In the multivariable analysis, the treatment regimen (C + N as a reference) was not significantly associated with PFS (hazard ratio: 0.76, P = 0.476). Favorable/intermediate International mRCC Database Consortium risk was identified as an independent prognostic factor for PFS.</p><p><strong>Conclusion: </strong>Treatment with C + N and L + P resulted in comparable PFS, OS, and safety profiles in patients with mRCC. Both regimens can be used to treat mRCC based on individual characteristics.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoendoscopic single-site versus conventional laparoscopic living donor nephrectomy: a systematic review and meta-analysis of randomized controlled trials.","authors":"Hanlin Liu, Li Wang, Jianwei Yang, Siyu Chen, Wei Shi, Xiaoran Li","doi":"10.1007/s11255-026-05183-4","DOIUrl":"https://doi.org/10.1007/s11255-026-05183-4","url":null,"abstract":"<p><strong>Background: </strong>Laparoendoscopic single-site donor nephrectomy (LESS-DN) has been proposed as a minimally invasive alternative to conventional laparoscopic donor nephrectomy (CLDN), but its perioperative advantages remain controversial. This meta-analysis aimed to compare the outcomes of LESS-DN and CLDN based on randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane Library were searched up to August 20, 2025, for English-language RCTs comparing LESS-DN and CLDN. The risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1.0), and pooled analyses were performed using Review Manager 5.4.1 software.</p><p><strong>Results: </strong>Four randomized controlled trials involving 274 donors (LESS-DN, n = 136; CLDN, n = 138) were included. There were no significant differences between groups in operative time, warm ischemia time, estimated blood loss, length of hospital stay, time to extraction, or overall complication rates.</p><p><strong>Conclusions: </strong>Based on the currently available randomized evidence, no statistically significant differences were detected between LESS-DN and CLDN in the perioperative outcomes analyzed in living kidney donors. Further adequately powered, multicenter randomized trials-particularly evaluating postoperative pain, patient-reported recovery, and cosmetic satisfaction-are warranted.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of PSA density in PI-RADS 3 lesions: a single-center retrospective observational study.","authors":"Patricia Rodriguez-Parras, Alberto Zambudio-Munuera, Ana Donaire-Barrera, Yaiza Yañez-Castillo, Maria Del Carmen Cano-Garcia, Miguel Arrabal-Martin, Miguel Angel Arrabal-Polo","doi":"10.1007/s11255-026-05179-0","DOIUrl":"https://doi.org/10.1007/s11255-026-05179-0","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate whether Prostate-specific antigen density (PSAD) improves risk stratification for clinically significant prostate cancer in patients with PI-RADS 3 lesions and to assess its potential role in reducing unnecessary biopsies.</p><p><strong>Methods: </strong>A single-center retrospective observational study was conducted at Hospital Universitario Clínico San Cecilio (Granada, Spain) between January 2022 and December 2025. A total of 203 patients with a PI-RADS 3 lesion who underwent systematic and targeted biopsy were included. Clinically significant prostate cancer was defined as ISUP ≥ 2. Univariate analysis, logistic regression (age and PSAD ≥ 0.15 ng/mL/cc), ROC curve analysis, and diagnostic performance metrics for PSAD ≥ 0.15 were performed.</p><p><strong>Results: </strong>Prostate cancer was detected in 73/203 patients (36%) and csPCa in 21/203 (10.3%). PSAD was higher in csPCa cases (0.17 vs 0.11; p = 0.001). PSAD ≥ 0.15 was independently associated with csPCa (OR 4.56; 95% CI 1.58-13.14; p = 0.005), as was age (OR 1.08 per year; p = 0.036). PSAD yielded an AUC of 0.722 and the combined age + PSAD model an AUC of 0.751. With PSAD ≥ 0.15, sensitivity was 76.2%, specificity 61.0%, and negative predictive value 95.7%.</p><p><strong>Conclusion: </strong>In conclusion, PSAD provides clinical value for risk stratification in PI-RADS 3 lesions and may support biopsy avoidance strategies in selected patients.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alignment between AI clinical decision tools and multidisciplinary tumor board decisions in prostate cancer.","authors":"Akif Koc, Oguzhan Akpinar, Alper Keskin, Halil Ibrahim Tarhan, Muhammet Guzelsoy","doi":"10.1007/s11255-026-05178-1","DOIUrl":"https://doi.org/10.1007/s11255-026-05178-1","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the concordance between treatment recommendations generated by LLMs and decisions made by a multidisciplinary uro-oncology tumor board.</p><p><strong>Methods: </strong>Forty-eight consecutive prostate cancer cases previously discussed at a multidisciplinary tumor board were retrospectively analyzed. For each case, treatment recommendations were generated using five LLM platforms (ChatGPT-4o, ChatGPT, Perplexity, Copilot, and DeepSeek) based on standardized clinical summaries. Four independent urology specialists evaluated the concordance between LLM recommendations and tumor board decisions using a 5-point Likert scale. Differences among models were assessed using the Friedman test followed by Bonferroni-corrected Wilcoxon signed-rank tests. Inter-rater agreement was calculated using the intraclass correlation coefficient.</p><p><strong>Results: </strong>Significant differences in concordance were observed among the evaluated AI platforms (χ² = 32.16, p < 0.001). Perplexity and ChatGPT-4o demonstrated the highest alignment with tumor board decisions, each achieving a median Likert score of 4.75, whereas Copilot showed the lowest concordance (median 3.00). DeepSeek and ChatGPT demonstrated intermediate performance. Post hoc analyses revealed that Perplexity significantly outperformed several lower-performing platforms; however, no statistically significant difference was observed between Perplexity and ChatGPT-4o (p = 0.149). Expert evaluations showed strong inter-rater agreement (ICC = 0.82).</p><p><strong>Conclusion: </strong>Large language models can demonstrate substantial concordance with multidisciplinary tumor board decisions in prostate cancer management. However, variability among models and the risk of hallucinated information indicate that LLMs should function as clinical decision-support tools under expert supervision rather than as autonomous decision-makers.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term safety of overactive bladder medications in men receiving pharmacotherapy for benign prostatic enlargement: a real-world study using inverse probability of treatment weighting.","authors":"Takeshi Soda, Tomoaki Yamauchi, Hikari Otsuka, Yuki Makino, Takuya Okada","doi":"10.1007/s11255-026-05172-7","DOIUrl":"https://doi.org/10.1007/s11255-026-05172-7","url":null,"abstract":"<p><strong>Purpose: </strong>Despite guideline recommendations to use overactive bladder (OAB) medications in men with benign prostatic enlargement (BPE) presenting with storage symptoms, prescription rates remain low, possibly due to concern about worsening voiding symptoms. We evaluated the impact of OAB medications on safety outcomes in men receiving pharmacotherapy for BPE in a real-world setting.</p><p><strong>Methods: </strong>We retrospectively reviewed 899 patients who received α-blockers, 5α-reductase inhibitors, or phosphodiesterase-5 inhibitors between April 2014 and December 2023. We assessed the association between adding antimuscarinics or β₃-agonists and acute urinary retention (AUR) using inverse probability of treatment weighting based on propensity scores; missing baseline covariates were handled by multiple imputation.</p><p><strong>Results: </strong>Median follow-up was 28.7 months. At baseline, OAB users had lower PSA (2.5 vs. 3.6 ng/mL), smaller prostate volume (35 vs. 43 mL), and lower post-void residual (PVR) (12 vs. 35 mL) than non-users (all p < 0.001). 5α-reductase inhibitor use was less common in the OAB group (16.1% vs. 23.8%; p = 0.019). AUR incidence did not differ significantly between groups before (log-rank p = 0.054) or after weighting (hazard ratio 1.18; 95% CI 0.38-3.62; p = 0.776). Among OAB-treated patients, baseline AUR was significantly associated with discontinuation due to increased PVR (hazard ratio 9.10; 95% CI 1.81-45.6; p = 0.010).</p><p><strong>Conclusion: </strong>In men with BPE on pharmacotherapy, addition of OAB medications was not associated with increased risk of AUR. Baseline AUR may predict subsequent discontinuation due to elevated PVR, indicating the need for careful monitoring in such patients.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction is not decision: why frailty must guide clinical choices in hemodialysis.","authors":"Fabrizio Cristiano","doi":"10.1007/s11255-026-05170-9","DOIUrl":"https://doi.org/10.1007/s11255-026-05170-9","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Holmium laser enucleation of the prostate after prostatic urethral lift: the state of bother.","authors":"Amir Patel, Jenny N Guo, Perry Xu, Alyssa McDonald, Allaa Fadl-Alla, Amy Krambeck","doi":"10.1007/s11255-026-05150-z","DOIUrl":"https://doi.org/10.1007/s11255-026-05150-z","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to investigate the effect PUL has on pre-operative irritative voiding symptoms in patients presenting for HoLEP, and if this leads to different post-operative outcomes.</p><p><strong>Methods: </strong>This is a single-institution retrospective analysis of our prospective HoLEP registry. Propensity score matching of prostate size and history of urinary retention was used to match the patients who had prior PUL with patients without prior benign prostatic hyperplasia (BPH) surgery 1:2. We analyzed baseline demographics, operative details, post-operative outcomes, and pre-operative/post-operative International Prostate Symptom Score (IPSS) and Michigan Incontinence Symptom Index (MISI).</p><p><strong>Results: </strong>Of the 2114 patients who underwent HoLEP, 1242 had sufficient data. There were 59 patients who had a HoLEP after prior PUL and a control cohort was made consisting of 118 patients. At baseline, the control group had more alpha blocker use (69% vs 54% (p=0.05)) and higher American Association of Anesthesia scores. Enucleation efficiency was similar between groups (1.82 vs 1.94 g/min (p=0.634)) but morcellation efficiency was lower in the PUL arm (9.8 vs 7.2 g/min (p<0.001)). More patients in the PUL cohort required anti-cholinergics and beta-3 agonists post-operatively (8.5% vs 19%, p=0.084). With regards to symptom scores, pre-operative MISI severity scores were significantly higher in the PUL group (median 6 vs 3 (p = 0.011)) and no other differences were noted.</p><p><strong>Conclusions: </strong>Patients presenting for HoLEP after prior PUL have significantly higher MISI severity scores. This does not translate to differences in post-operative outcomes compared to those who had HoLEP as their first BPH surgery.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}