International Urology and Nephrology最新文献

{"title":"Non-contrast CT radiomics for identifying nonfunctioning kidneys: a multicenter development and external validation study.","authors":"Yufei Jiang, Yihan Zheng, Zechen Feng, Liuru Bao, Qiang Wei","doi":"10.1007/s11255-026-05451-3","DOIUrl":"https://doi.org/10.1007/s11255-026-05451-3","url":null,"abstract":"<p><strong>Purpose: </strong>In urological practice, the decision to resect or preserve a kidney with obstruction, tumor or atrophy is based on split renal function, although SPECT renal dynamic scintigraphy as the reference standard is resource-intensive. We developed and externally validated a non-contrast CT radiomics model to identify nonfunctioning kidneys and support urological decision-making in this setting.</p><p><strong>Methods: </strong>In this three-center retrospective study (TRIPOD+AI), adults underwent non-contrast CT and SPECT renal dynamic scintigraphy within 72 h. IBSI-compliant radiomics features were extracted with PyRadiomics, and between-kidney asymmetry features were constructed. After three-stage selection (Spearman, recursive feature elimination, and LASSO), 12 machine learning models were developed and externally validated in 2 independent cohorts. A Rad-score and clinical nomogram were also derived.</p><p><strong>Results: </strong>Among 1029 patients, the internal cohort included 418 patients. Twenty-three of features were retained. The random forest model yielded an internal test AUC of 0.9426, sensitivity of 85.5%, specificity of 88.3%, and negative predictive value of 95.6%. Its external AUCs were 0.875 and 0.913. The nomogram attained external AUCs of 0.920 and 0.881. At the thresholds fixed in the training data, the random forest achieved external sensitivity of 66.0 and 76.4% with negative predictive values of 94.8 and 93.3%, and the nomogram 92.5 and 93.7% with 98.3 and 97.2%. Both radiomics models outperformed logistic-regression baselines built from clinical variables and simple CT size and asymmetry measurements, although the margin over the combined baseline was not statistically significant in one external cohort. The Rad-score was correlated with single-kidney GFR (ρ = -0.738, P < 0.001) and facilitated risk stratification.</p><p><strong>Conclusion: </strong>Non-contrast CT radiomics identified nonfunctioning kidneys without contrast agents or radiotracers. Because non-contrast CT is already part of routine urological workup, this externally validated rule-out tool may reduce unnecessary SPECT examinations and support decisions between nephrectomy and nephron-sparing management.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227872","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":"A study on the dose-response relationship between glycemic variability and in-dialysis hypotension in patients with diabetes undergoing hemodialysis.","authors":"Wei Shi","doi":"10.1007/s11255-026-05388-7","DOIUrl":"https://doi.org/10.1007/s11255-026-05388-7","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the dose-response relationship between Glycemic variability (GV) and Intradialytic hypotension (IDH) in diabetic hemodialysis (MHD) patients, identify the critical Coefficient of variation (CV) threshold, and inform precision glucose management.</p><p><strong>Methods: </strong>This prospective cohort enrolled 240 diabetic MHD patients (2023-2024). Continuous glucose monitoring provided GV parameters (CV, MAGE, SD). Patients were divided into IDH (n = 98) and non-IDH (n = 142) groups. Restricted cubic spline (RCS) analyzed dose-response; multivariate logistic regression assessed independent effects, with Subgroup analysis and interaction tests.</p><p><strong>Results: </strong>CV was significantly higher in the IDH group (42.3% vs. 26.5%, P<0.001). RCS revealed a nonlinear positive correlation (P<0.001). When CV>36%, IDH risk increased sharply (threshold effect). Each 10% CV rise increased IDH risk by 98.4% (OR 1.984). Compared to Q1, Q3 (OR 3.512) and Q4 (OR 8.637) showed significantly higher risk. Associations were stronger in patients aged ≥60 years, dialysis duration ≥36 months, or with cardiovascular disease (interaction P<0.05). CV predicted IDH with AUC=0.856; optimal cutoff 36.5% (sensitivity 78.6%, specificity 82.4%).</p><p><strong>Conclusion: </strong>A significant dose-response relationship exists between GV and IDH. CV>36% is an independent risk factor. Maintaining CV below 36% may reduce IDH risk and improve outcomes.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224056","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 outcomes between transperitoneal and retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis of comparative studies.","authors":"Guoqing Zhu, Bin Zeng, Jie Yang, Weizhen Zhu, Weichao Huang, Sheng Wang, Wei Zhang, Xingyu Xiong, Hang Xu, Lu Yang","doi":"10.1007/s11255-026-05438-0","DOIUrl":"https://doi.org/10.1007/s11255-026-05438-0","url":null,"abstract":"<p><strong>Objective: </strong>To compare the perioperative and functional outcomes of transperitoneal (TP) and retroperitoneal (RP) approaches in robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC).</p><p><strong>Methods: </strong>A systematic literature search of PubMed, Web of Science, Cochrane, Embase, and ClinicalTrials.gov was conducted from inception to April 2026. Comparative studies that reported the outcomes of interest between TP RAPN and RP RAPN for renal cell carcinoma were included. Pooled effective sizes, including odds ratio (OR) and weighted mean differences (WMD) with 95 confidence intervals (CI), were estimated under fixed or random effect models. Further sensitivity analyses were performed to explore potential sources of heterogeneity. The study protocol was prospectively registered on PROSPERO (CRD420261390561).</p><p><strong>Results: </strong>A total of 32 comparative studies were included, involving 6299 patients in the TP RAPN group and 4583 in the RP RAPN group, respectively. No significant differences were observed in baseline characteristics. Patients undergoing RP RAPN had a shorter operation time (OT, WMD: 15.53 min, 95%CI 9.24-21.83, P < 0.001), lower estimated blood loss (EBL, WMD: 32.34 ml, 95%CI 21.9-42.78, P < 0.001), and shorter length of stay (LOS, WMD: 0.42 days, 95%CI 0.22-0.63, P < 0.001) compared to TP RAPN. No significant differences were observed in warm ischemia time (WIT, P = 0.24), conversion to open or radical surgery (P = 0.11 and P = 0.18, respectively), positive surgical margin (PSM, P = 0.22), overall complications (P = 0.08), major complications (the Clavien-Dindo classification ≥ 3, P = 0.32), or postoperative renal function (postoperative estimated glomerular filtration rate (eGFR): P = 0.22; postoperative 3-6 month eGFR: P = 0.49; postoperative 1-year eGFR: P = 0.55). Further sensitivity analyses validated the above findings.</p><p><strong>Conclusions: </strong>This study suggests that the RP RAPN may be superior to TP RAPN in terms of shorter OT, lower EBL, and shorter LOS. Nevertheless, given the limitations of this analysis, these findings should be interpreted cautiously, and further well-designed randomized controlled trials are required to validate our results.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220315","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":"Institutional billed-charge patterns and resource utilization in flexible navigable aspiration sheath-assisted and no-access-sheath ureteroscopy: a single-center descriptive cohort study.","authors":"Christina Schweitzer, Phyo Phyo Min Thu, Amar Kassim, Abdulla Sabry, Marly Aziz, Dariush Khezrimotlagh, Akin S Amasyali","doi":"10.1007/s11255-026-05445-1","DOIUrl":"https://doi.org/10.1007/s11255-026-05445-1","url":null,"abstract":"<p><strong>Purpose: </strong>To describe institutional billed-charge patterns and resource utilization in flexible navigable aspiration sheath (FANS)-assisted ureteroscopy and ureteroscopy performed without a ureteral access sheath (NoUAS), recognizing that the two pathways were used in clinically different populations.</p><p><strong>Methods: </strong>We retrospectively evaluated 88 ureteroscopy cases performed by a single endourologist from September 2024 through August 2025. Preoperative stone volume was manually derived from computed tomography measurements using an ellipsoid approximation. Continuous variables are reported as median (interquartile range [IQR]) and compared with Wilcoxon rank-sum tests; categorical variables used Fisher exact tests. Because case mix and site of service were markedly imbalanced and numeric operative-time data were incomplete for outpatient cases, comparisons were treated as descriptive rather than as estimates of an independent device effect.</p><p><strong>Results: </strong>Thirty-six cases used FANS and 52 used NoUAS. FANS cases had greater median stone volume (553 [IQR 257-1,141] vs 208 [115-463] mm³; p=0.001), more frequent intrarenal involvement (29/35 vs 24/51; p=0.001), longer operative time among cases with numeric data (110 [93-134] vs 70 [55-94] min; p<0.001), and more frequent main hospital treatment (25/36 vs 18/52; p=0.002). Charge data were available for 33 FANS and all 52 NoUAS cases. Median total billed charge was $49,919 [46,088-58,100] and $6,330 [3,162-51,306], respectively (p=0.003); within-site differences were not statistically significant.</p><p><strong>Conclusion: </strong>FANS cases occurred within a more complex, higher-charge care pathway, but the observed differences cannot be attributed to the device itself. These data provide an institutional benchmark for future analyses using clinically comparable cohorts, standardized outcomes, and actual cost data.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193727","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":"Associations between diet quality and testosterone: evidence from mixture and mediation analysis.","authors":"Huang Yu, Hui Xu, Chunlin Huang, Zhe Luo, Ke Li","doi":"10.1007/s11255-026-05443-3","DOIUrl":"https://doi.org/10.1007/s11255-026-05443-3","url":null,"abstract":"<p><strong>Background: </strong>While higher diet quality is associated with improved testosterone levels, prior population-based evidence relied on binary testosterone deficiency outcomes. The continuous dose-response relationship, component-specific contributions and adiposity-mediated mechanisms linking diet quality to testosterone remain unclear.</p><p><strong>Objective: </strong>To examine the association between overall diet quality and serum testosterone in adult men, identify key dietary components and evaluate adiposity-mediated pathways.</p><p><strong>Methods: </strong>This cross-sectional study included 5434 adult males from the National Health and Nutrition Examination Survey (2011-2016). Diet quality was assessed using Healthy Eating Index-2020 (HEI-2020) from 24-h dietary recalls. Testosterone was quantified by liquid chromatography-tandem mass spectrometry. Associations were evaluated using multivariable linear regression, restricted cubic spline analysis, mixture models (weighted quantile sum, quantile g-computation and Bayesian kernel machine regression) and mediation analysis.</p><p><strong>Results: </strong>Higher HEI-2020 scores were significantly associated with increased log-transformed total testosterone (β per 10-point increase = 0.015; 95% CI: 0.002-0.028; P = 0.028), demonstrating a significant positive linear dose-response relationship. Mixture analyses assigned highest relative weights to sodium and dairy components. The effects were potentially mediated through body mass index and waist circumference.</p><p><strong>Conclusions: </strong>Higher overall diet quality exhibits a positive linear association with elevated serum testosterone in adult men. In exploratory mixture and mediation analyses, sodium, dairy and adiposity were identified as possible contributors.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193698","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":"Response to the letter to the editor regarding \"Glucagon and GLP-1 in Hemodialysis: Associations with Mortality and Nutritional Decline\".","authors":"Elad Nizri, Lawi Suissa, Ada Azar, Racheli Gamliel, Ramzia Abu Hamad, Orli Turgeman, Shai Efrati, Ilia Beberashvili","doi":"10.1007/s11255-026-05435-3","DOIUrl":"https://doi.org/10.1007/s11255-026-05435-3","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193714","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":"National penile cancer surgery centralisation in Ireland: five-year service performance, survival, and recurrence outcomes.","authors":"Diarmuid D Sugrue, Charlie Eddershaw, Dearbhail Ní Chaoimh, Eilis Ní Chinneide, Brian O' Neill, Min Yuen Teo, Niall F Davis, Ivor M Cullen","doi":"10.1007/s11255-026-05429-1","DOIUrl":"https://doi.org/10.1007/s11255-026-05429-1","url":null,"abstract":"<p><strong>Purpose: </strong>The provision of penile cancer care in specialist centres decreases overtreatment and improves patient outcomes. Penile cancer care was centralised in the Republic of Ireland in 2021. We assess five-year service performance versus international standards, oncologic outcomes, and evaluate risk factors for disease recurrence.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data was performed. All patients undergoing penile cancer surgery at the National Penile Cancer Centre from January 2021 to July 2025 were included. Service metrics were compared against NHS and European Association of Urology standards. Overall survival (OS) was estimated by Kaplan-Meier. Multivariable logistic regression was carried out to assess factors associated with disease recurrence and mortality.</p><p><strong>Results: </strong>151 patients were included. Phallus preservation was performed in 77% (n = 116). Centralisation met or approached most international targets, but timely multidisciplinary discussion lagged. Definitive treatment was received by 80% of patients (n = 121) within 62 days. Median OS was 58.7 months; 1 and 3-year disease-specific survival was 90% and 82%, respectively. Lymph node positivity (OR 8.29, 95% CI 2.01-34.3, p = 0.003), lymphovascular invasion (OR 4.58, 95% CI 1.48-14.22, p = 0.008) and perineural invasion (OR 5.83, 95% CI 1.84-18.51, p = 0.003) were associated with increased risk of mortality on univariate analysis. Local recurrence was 6% (n = 7) following organ-sparing surgery. Positive margins were significantly associated with higher recurrence risk on multivariate analysis (OR 3.20, 95% CI 1.02-10.04, p = 0.046).</p><p><strong>Conclusion: </strong>Centralisation of penile cancer services has delivered high rates of organ preservation and guideline-concordant care. Gaps in multidisciplinary discussion and pathological reporting identify priorities for ongoing service improvement.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181521","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":"Revisiting sexual dysfunction in peritoneal dialysis: methodological and reporting concerns.","authors":"Muhammad Yusuf Khan, Hasan Ali Malick, Bilal Arshad","doi":"10.1007/s11255-026-05440-6","DOIUrl":"https://doi.org/10.1007/s11255-026-05440-6","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181606","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":"Multi-omics analyses based identification of therapeutic targets for rapid kidney function decline and chronic kidney disease, a mendelian randomization study.","authors":"Lei-Yun Wang, Qiu-Qi Li, Xiang-Yu Yang, Xin-Qi Teng, Lu-Lu Li, Shao-Hui Zhang","doi":"10.1007/s11255-026-05425-5","DOIUrl":"https://doi.org/10.1007/s11255-026-05425-5","url":null,"abstract":"<p><strong>Purpose: </strong>Rapid kidney function decline and chronic kidney disease (CKD) remain significant threats to global health. Currently, there are no effective therapeutic agents capable of reversing progression of CKD. A two-stage Mendelian randomization (MR) study was conducted to uncover causal therapeutic mechanisms of pQTLs during kidney function decline.</p><p><strong>Methods: </strong>Exposure data comprised 4,853 distinct proteins and their corresponding protein quantitative trait loci (pQTLs, p < 5×10^-8) sourced from 7 large-scale proteomic datasets. Kidney function decline outcomes of 1,201,909 participants and 337,109 participants were collected as the outcome in the discovery stage and validation stage, respectively. Additionally, single cell sequencing analyses from 64,276 mice cells served as an independent cohort to explore the expression level of these potential therapeutic targets in kidney. Protein-protein and protein-drug association analysis were performed in the STITCH database, with supplementary drug-related data extracted from DrugBank database to explore potential therapeutic options.</p><p><strong>Results: </strong>A total of 37 proteins (p < 1.03×10^-5) were associated with impaired kidney function, among which 7 proteins (IGFBP4, CLMP, FGF5, ANGPTL7, LRRN1, DMKN and CHST11) were validated. Lower IGFBP4 expression level was observed during the rapid kidney function decline in mice. Besides, dbcAMP and pioglitazone emerged as candidate agents with the potential to act through IGFBP4 and CLMP in rapid decline and CKD.</p><p><strong>Conclusion: </strong>IGFBP4 and CLMP represent promising therapeutic targets for rapid kidney function decline and CKD. Further investigation is warranted to elucidate the underlying mechanisms and validate their functional roles through larger cohort studies.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164507","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":"Four cases of type III collagen deposition glomerulopathy and summary of the literature.","authors":"Xinyi Lin, Yupeng Xu, Xinti Lin, Yanling Xiong, Yinqiu Lv, Huidi Zhang","doi":"10.1007/s11255-026-05431-7","DOIUrl":"https://doi.org/10.1007/s11255-026-05431-7","url":null,"abstract":"<p><p>Collagen type III glomerulopathy is a rare glomerular disorder characterized by the deposition of type III collagen fibers within the glomeruli, predominantly in the mesangial and subendothelial regions. Renal biopsy with histopathological examination remains the gold standard for diagnosis of this disease. Clinically, collagen type III glomerulopathy typically presents with proteinuria and progressive renal dysfunction, with or without nephrotic syndrome. Collagen type III glomerulopathy affects individuals across all age groups, ranging from children to adults, and shows no apparent sex predominance. This study retrospectively analyzed four patients with collagen type III glomerulopathy diagnosed at the First Affiliated Hospital of Wenzhou Medical University between 2011 and 2024 and reviewed 105 cases reported worldwide in the English-language literature. All patients presented with proteinuria, and half had renal impairment. Electron microscopy consistently demonstrated abnormal collagen fibrils in the mesangial region. Over a median follow-up of 71.5 months, half of the patients with available follow-up data progressed to end-stage renal disease, whereas the remaining patients maintained stable renal function after intervention. Globally, reported collagen type III glomerulopathy cases exhibited heterogeneous clinical presentations, and current data support an association between nephrotic-range proteinuria and poorer renal outcomes.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166091","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}