International Urology and Nephrology最新文献

{"title":"Endoscopic combined intrarenal surgery versus prone percutaneous nephrolithotomy for complex renal stones: critical assessment of a randomized trial.","authors":"Kareem Noah, Khaled Algamal, Tarek Elliethy, Wael Saber, Mahmoud Mobark, Mohamed Alhefnawy","doi":"10.1007/s11255-025-04445-x","DOIUrl":"https://doi.org/10.1007/s11255-025-04445-x","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of endoscopic combined intrarenal surgery (ECIRS) in the Galdakao-Modified Supine Valdivia (GMSV) position versus percutaneous nephrolithotomy (PCNL) in the prone position for managing complex kidney stones.</p><p><strong>Methods: </strong>This prospective, randomized study was conducted in the urology departments of Benha University Hospital and Theodor Bilharz Research Institute between June 2021 and May 2024. A total of 60 patients with complex renal stones were randomly assigned to two groups (30 patients each). Group A underwent conventional percutaneous nephrolithotomy (PCNL) in the prone position, while Group B underwent endoscopic combined intrarenal surgery (ECIRS) in the Galdakao-Modified Supine Valdivia (GMSV) position. Data on demographic characteristics, clinical outcomes, perioperative parameters, and stone-free rates (SFR) were collected.</p><p><strong>Results: </strong>No significant differences were found between the two groups regarding preoperative demographic data and stone characteristics. However, operative time was significantly longer in the PCNL group (119 ± 18 min) compared to the ECIRS group (105 ± 14 min) (P = 0.002). The number of punctures was also significantly higher in the PCNL group than in the ECIRS group (P = 0.001). Immediate success was notably higher in the ECIRS group (83.3%) compared to the PCNL group (53.3%) (P = 0.012). However, no significant difference was observed between the groups concerning eventual success (P = 1.0).</p><p><strong>Conclusion: </strong>ECIRS is a highly effective treatment for complex renal stones, delivering favorable outcomes such as higher single-step stone-free rates, a lower incidence of adverse events, and a reduced need for auxiliary procedures.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742931","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":"Efficacy and safety of routine corticosteroid premedication in enfortumab vedotin therapy for advanced urothelial carcinoma.","authors":"Takuto Hara, Kotaro Suzuki, Taisuke Tobe, Hideto Ueki, Naoto Wakita, Yasuyoshi Okamura, Yukari Bando, Tomoaki Terakawa, Yoji Hyodo, Koji Chiba, Jun Teishima, Akihisa Yao, Hideaki Miyake","doi":"10.1007/s11255-025-04462-w","DOIUrl":"https://doi.org/10.1007/s11255-025-04462-w","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the efficacy and safety of routine corticosteroid premedication with dexamethasone for preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving enfortumab vedotin (EV) for previously treated advanced urothelial carcinoma (UC). Furthermore, we assessed the impact of this strategy on treatment continuity and the incidence of dermatologic toxicities.</p><p><strong>Methods: </strong>We retrospectively analyzed 48 patients with unresectable or metastatic UC who received EV at our institution. All patients received 6.6 mg of intravenous dexamethasone prior to each EV infusion (1.25 mg/kg on Days 1, 8, and 15 of each 28-day cycle). Adverse events (AEs) were graded according to the National Cancer Institute Common Terminology Criteria for AEs version 5.0. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method, and factors influencing time to cutaneous toxicity onset were analyzed using Cox proportional hazards regression.</p><p><strong>Results: </strong>The median PFS was 4.6 months (95% CI: 3.5-10.8), and the median OS was 14.8 months (95% CI: 7.4-20.0). Grade 1-2 nausea was observed in six patients (14.6%), with no Grade ≥ 3 nausea reported. Dermatologic toxicity occurred in 13 patients (31.7%), all Grade 1-2, and none required systemic corticosteroid therapy. Patients with normal serum albumin levels experienced significantly earlier cutaneous toxicity onset compared with those with abnormal levels (p = 0.015). Treatment continuity was largely maintained, with minimal severe AEs leading to discontinuation. However, the study's single-center, retrospective design and small sample size may limit the generalizability of these findings, warranting further prospective validation.</p><p><strong>Conclusion: </strong>Routine dexamethasone premedication in patients receiving EV was feasible and associated with a low incidence of severe nausea and cutaneous toxicity. While these findings suggest a potential role for corticosteroids in CINV control and cutaneous toxicity mitigation, the retrospective design and absence of a control group preclude definitive conclusions. Further prospective studies are needed to clarify the impact of corticosteroid premedication in this setting.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730001","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":"Lipoprotein(a) levels and cardiovascular mortality risk in Chinese patients undergoing hemodialysis.","authors":"Qiaojing Liang, Guojuan Zhang, Liping Jiang, Binghan Li, Kangkang Song","doi":"10.1007/s11255-025-04459-5","DOIUrl":"https://doi.org/10.1007/s11255-025-04459-5","url":null,"abstract":"<p><strong>Purpose: </strong>Lipoprotein(a) (Lp(a)) is recognized as an independent risk factor for cardiovascular disease (CVD) in the general population. However, its impact on CVD mortality among Chinese patients undergoing maintenance hemodialysis (MHD) has not been fully established. This study aimed to evaluate the association between Lp(a) levels and both CVD mortality and all-cause mortality in this population.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted involving 200 MHD patients from Beijing Tongren Hospital, analyzed from January 1, 2013, to July 1, 2024. The mortality outcomes included CVD-related and all-cause mortality. Kaplan-Meier survival curves were utilized to assess the impact of Lp(a), while Cox regression analysis and restrict cubic spline were performed to explore associations.</p><p><strong>Results: </strong>The median follow-up duration was 66.5 months, with 121 deaths recorded (60.5%), of which 66 (54.5%) were due to CVD. Kaplan-Meier analysis indicated that patients in the highest tertile of Lp(a) levels had the lowest survival for both CVD mortality and all-cause mortality. In multivariable Cox regression, higher Lp(a) levels were independently associated with an increased risk of both CVD mortality and all-cause mortality. The restricted cubic splines regression model showed that the risk of CVD mortality and all-cause mortality increased with rising Lp(a) levels.</p><p><strong>Conclusion: </strong>Elevated serum Lp(a) levels are independently associated with increased mortality from both CVD and all causes in Chinese MHD patients. These findings indicate that serum Lp(a) may be a significant risk factor for CVD mortality in this population.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700485","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":"New equation for estimating glomerular filtration rate in Vietnamese kidney transplant recipients.","authors":"Bao An Huynh, Nguyen Huy Hoang Ho, Thi Tram Anh Bui, Khac Chuan Hoang, Thai Thanh Tam Tran","doi":"10.1007/s11255-025-04458-6","DOIUrl":"https://doi.org/10.1007/s11255-025-04458-6","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate assessment of kidney function is essential for post-kidney transplant management. This study aims to develop a new equation tailored to Vietnamese kidney transplant recipients and validate its performance against established equations.</p><p><strong>Methods: </strong>A total of 299 kidney transplant recipients underwent glomerular filtration rate (GFR) measurement using technetium-99m-diethylenetriaminepentaacetate renal dynamic scintigraphy, along with demographic, clinical, and laboratory assessments. Participants were divided into a development cohort (n = 150) to generate a new GFR-estimating equation and a validation cohort (n = 149) for internal validation against six equations.</p><p><strong>Results: </strong>The new equation, <math><mrow><mi>G</mi> <mi>F</mi> <mi>R</mi> <mo>=</mo> <mn>100.430</mn> <mo>×</mo> <mn>1</mn> <mo>.</mo> <msup><mn>080</mn> <mrow><mi>sex</mi></mrow> </msup> <mo>×</mo> <mi>a</mi> <mi>g</mi> <msup><mi>e</mi> <mrow><mo>-</mo> <mn>0.097</mn></mrow> </msup> <mo>×</mo> <mi>S</mi> <mi>c</mi> <msup><mi>r</mi> <mrow><mo>-</mo> <mn>0.524</mn></mrow> </msup> <mo>×</mo> <mi>S</mi> <mi>c</mi> <mi>y</mi> <msup><mi>s</mi> <mrow><mo>-</mo> <mn>0.435</mn></mrow> </msup> </mrow> </math> (sex: 0 = female; 1 = male), showed the smallest median bias (-0.11 [-1.40; 1.11]), highest P₃₀ accuracy (94.0% [88.6; 96.6]), highest precision (interquartile range = 9.82 [7.63; 12.37]), and strongest correlation with measured GFR (r = 0.824 [0.752; 0.880]) among tested equations in the validation cohort. Among creatinine-based equations, the Modification of Diet in Renal Disease equation was the most accurate.</p><p><strong>Conclusion: </strong>The new equation outperformed established equations and is recommended for Vietnamese kidney transplant recipients. The Modification of Diet in Renal Disease equation may serve as an alternative in centers lacking access to serum cystatin C. Further studies with larger cohorts, external validation, and comparisons with gold-standard GFR measurement methods are needed to confirm these results.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700487","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":"Microscopic single-tubule technique for spermatocelectomy in cases of spermatocele: a rarely used surgical method and ıts outcomes.","authors":"Mehmet Sefa Altay, Ömer Uslu, Fevzi Bedir, Hüseyin Kocatürk, Ibrahim Karabulut, Banu Bedir, Şaban Oğuz Demirdöğen, Isa Özbey","doi":"10.1007/s11255-025-04464-8","DOIUrl":"https://doi.org/10.1007/s11255-025-04464-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to promote the microscopic single-tubule spermatocelectomy technique. The technique significantly reduces the risks of epididymal injury, infertility, and spermatocele recurrence rates.</p><p><strong>Methods: </strong>From January 2015 to June 2024, male patients aged between 18 and 50 years who underwent microscopic single-tubule spermatocelectomy with the intent to preserve fertility were included in this study. Data on patient age, preoperative and postoperative sperm analysis results, and complication rates were recorded. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) v26 for Windows.</p><p><strong>Results: </strong>The mean age of the patients was 40.93 ± 6.20 years. The average size of the spermatoceles was 6.44 ± 2 cm. The mean duration of the operation was 45.44 ± 8.82 min. While there was no statistically significant difference in sperm count and volume averages between preoperative and postoperative measurements, a statistically significant was observed in sperm motility. In terms of complications, 3.7% of the patients (n = 1) developed an infection. No epididymal bleeding or iatrogenic tubule opening was detected under the microscope. None of the patients experienced bleeding, spermatocele recurrence, testicular atrophy, or sperm granuloma. Pathological evaluations revealed no epididymal tissue in any of the cases.</p><p><strong>Conclusion: </strong>Microscopic single-tubule spermatocelectomy reduces the risk of epididymal injury and testicular atrophy, and it is associated with low complication rates. Particularly in male patients desiring fertility preservation, microscopic single-tubule spermatocelectomy offers high success rates and low complication rates and should be considered the preferred surgical technique.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692180","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":"Safety and efficacy of WVTT (Rezum) in young men: preliminary data.","authors":"Antonio Minore, Loris Cacciatore, Giovanni Ferrari, Giampaolo Siena, Raffaele Balsamo, Simone Morselli, Roberto Castellucci, Francesco Varvello, Luca Cindolo","doi":"10.1007/s11255-025-04463-9","DOIUrl":"https://doi.org/10.1007/s11255-025-04463-9","url":null,"abstract":"<p><strong>Objectives: </strong>Water vapor thermal therapy (WVTT) is one of the latest developed minimally invasive surgical treatments (MIST) for benign prostatic hyperplasia-related symptoms (LUTS/BPH). We focused on the functional outcomes of patients < 50 years treated with Rezūm for BPH.</p><p><strong>Methods: </strong>We prospectively recorded data on patients treated with Rezūm at 5 institutions from April 2020 to June 2021. Uroflowmetry, prostatic specific antigen (PSA), ultrasonography assessing prostate volume and post voiding residual volume (PVR), the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), and the question yes/no assessing ejaculatory dysfunction were recorded at baseline, and 3, 6 and 12 months later.</p><p><strong>Results: </strong>Ten patients were enrolled. The median operative time was 9 (IQR 8.25-13) min. All patients were dismissed a few hours after surgery with an indwelling urinary catheter that was removed after a median of 7 days (IQR 7-7). Each patient experienced an improvement both in terms of IPSS domain and in terms of maximal flow (Qmax) and PVR with a significative difference from the baseline observed at 3 months, stable until the last follow-up. Everyone maintained or gained antegrade ejaculation. No major post-operative complications were recorded, as just one patients experienced acute urinary retention after catheter removal.</p><p><strong>Conclusions: </strong>WVTT treatment is a feasible and safe minimally invasive option for patients < 50 y old with LUTS/BPH and showed optimal early functional outcomes.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691655","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":"Role and application prospective of non-steroidal MRA in the treatment of diabetic kidney disease.","authors":"Yu Sun, Mingzhu Wang","doi":"10.1007/s11255-025-04456-8","DOIUrl":"https://doi.org/10.1007/s11255-025-04456-8","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) has diverse etiologies and complex pathogenesis, and is prone to recurrent episodes and prolonged illness. In recent years, the prevalence of CKD has been increasing year by year, and the global prevalence in the general population has reached 14.3%. Diabetic kidney disease (DKD) is a common complication of diabetes mellitus (DM), and about 20-40% of DM patients have combined DKD, which is also the main cause of CKD and end-stage renal disease (ESRD). DM catalyzes CKD in approximately 30-50% of global cases, affecting around 285 million individuals. It primarily triggers diabetic nephropathy (DN), the leading cause of end-stage renal disease worldwide. Research indicates that activation of the mineralocorticoid receptor (MR) plays a role in the onset and progression of DKD. Counteracting MR overactivation offers antioxidative, anti-inflammatory, and anti-fibrotic benefits, thereby ameliorating target organ damage. MR antagonists (MRAs) such as spironolactone and eplerenone have been validated for renal protection. However, their clinical application is hindered by adverse effects including hyperkalemia, gynecomastia in males, erectile dysfunction, and menstrual irregularities in females. Finerenone, a novel non-steroidal MRA, exhibits a unique mechanism of action, binding to MR and inhibiting the recruitment of transcription co-factors involved in gene expression, effectively slowing the progression of diabetic nephropathy (DN). In addition, finerenone demonstrates improved safety and efficacy in treating heart failure and chronic kidney disease. It also plays a significant role in the management of atrial fibrillation and myocardial infarction. This article reviews recent studies on finerenone, summarizing its mechanism of action in treating DN, evidence from clinical trials, adverse reactions, combined use with other inhibitors, and future prospective, aiming to provide insights for the prevention and treatment of DN.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692183","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":"Liquid-based kidney injury molecule-1 as a diagnostic and prognostic indicator in renal cell carcinoma: A systematic review and meta-analysis.","authors":"Sike He, Dingbang Liu, Junru Chen, Xingming Zhang, Jiayu Liang, Jinge Zhao, Xu Hu, Zhenhua Liu, Hao Zeng, Guangxi Sun","doi":"10.1007/s11255-025-04447-9","DOIUrl":"https://doi.org/10.1007/s11255-025-04447-9","url":null,"abstract":"<p><strong>Purpose: </strong>Noninvasive biomarkers for renal cell carcinoma (RCC) are vital but scarce. Kidney injury molecule-1 (KIM-1) is a transmembranous glycoprotein that is sensitive and specific to kidney injury. KIM-1 is overexpressed in RCC, and its ectodomain can be detected in blood and urine. Here, we explored whether KIM-1 is a diagnostic or prognostic indicator in RCC.</p><p><strong>Methods: </strong>A comprehensive online literature search was performed in PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrails, and Database of major urological or oncological congress. We screened the literature and extracted the data according to the selection criteria. The quality of eligible studies was measured via the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa scale. The certainty of the evidence (CoE) was assessed by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) score. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the curve of the summary receiver operating characteristic curve (AUROC), and survival outcomes were subsequently estimated in Stata and MetaDisc. Subgroup analysis, meta-regression, and sensitivity analysis were performed to reveal the source of heterogeneity.</p><p><strong>Results: </strong>A total of eight studies were included for further analysis. The pooled sensitivity of KIM-1 for RCC diagnosis was 0.78 (95% CI: 0.69-0.85, I² = 84.61%, p < 0.01), and the pooled specificity was 0.79 (95% CI: 0.65-0.89, I² = 90.72%, p < 0.01). The AUROC was 0.85 (95% CI: 0.82-0.88). A moderate CoE was indicated by GRADE score. A higher KIM-1 level was associated with worse disease-free survival (HR = 1.76, 95% CI: 1.48-2.09, I² = 0.00%, p < 0.001). Study continent, number of study center, and sample type are the potential contributors of heterogeneity.</p><p><strong>Conclusion: </strong>Liquid-based KIM-1 is a promising noninvasive biomarker for early RCC detection, surveillance, and prognosis prediction. More validations in large cohorts are needed to confirm these findings.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673762","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":"Development and validation of a predictive model for postoperative metastasis of upper tract urothelial carcinoma after radical nephroureterectomy and analysis of risk factors for different metastatic sites: a multicenter study.","authors":"ZiMing Kang, Cheng Wang, WanRong Xu, Biao Zhang, JiangHou Wan, HengPing Li, PanFeng Shang","doi":"10.1007/s11255-025-04455-9","DOIUrl":"https://doi.org/10.1007/s11255-025-04455-9","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a prediction model for assessing the risk of postoperative metastasis in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) and to analyze independent risk factors for metastasis at different sites.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 555 UTUC patients who underwent RNU at 3 medical centers between January 2012 and August 2023. Patients were randomly divided into a training cohort (n = 388) and a validation cohort (n = 167) at a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed in the training cohort to identify postoperative metastasis risk factors. A nomogram was developed based on these factors and validated. In addition, independent risk factors for metastasis at different sites were analyzed.</p><p><strong>Results: </strong>Among the 555 patients, 122 (22.0%) developed postoperative metastasis. Middle and lower ureteral tumors, T stage ≥ T3, high-grade tumors, lymphovascular invasion (LVI), and a prognostic nutritional index (PNI) < 48.75 were associated with poorer metastasis-free survival (MFS). The nomogram achieved C-indexes of 0.816 and 0.812 in the training and validation cohorts. Age < 65 years was a risk factor for lymph node metastasis, tumor size and necrosis predicted liver metastasis, and a higher preoperative platelet-to-lymphocyte ratio (PLR) was associated with bone metastasis. Median overall survival (OS) for lymph node, lung, liver, multiple sites, bone, and brain metastasis were 14, 10, 6, 5.5, 5, and 4.5 months, respectively.</p><p><strong>Conclusion: </strong>The prediction model developed effectively assesses postoperative metastasis risk in UTUC patients' aids in guiding individualized treatment. The risk factors for different metastasis sites are generally similar, with slight variations, which may offer new directions for future research on site-specific therapeutic strategies.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673752","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 digital dialogue on premature ejaculation: evaluating the efficacy of artificial intelligence-driven responses.","authors":"Hakan Anıl, Mehmet Vehbi Kayra","doi":"10.1007/s11255-025-04461-x","DOIUrl":"https://doi.org/10.1007/s11255-025-04461-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the quality and comprehensibility of responses generated by three prominent artificial intelligence-powered chatbots (ChatGPT, Gemini, and Llama) when queried about premature ejaculation (PME).</p><p><strong>Methods: </strong>A set of 25 frequently asked questions (FAQs) were identified on the basis of Google Trends and Semrush platforms. Each chatbot was prompted with these questions and their responses were analyzed via a comprehensive set of metrics. Readability was assessed via the Flesch Reading Ease (FRES) and Flesch-Kincaid Grade Level (FKGL) scores. Quality and reliability were evaluated via the modified DISCERN (mDISCERN) and Ensuring Quality Information for Patients (EQIP) scores, which assess the clarity, comprehensiveness, and trustworthiness of health information.</p><p><strong>Results: </strong>Readability scores, as assessed by FRES and FKGL, did not significantly differ across the three chatbots. In terms of quality, the mean EQIP scores were significantly different between the models, with Llama (72.2 ± 1.1) achieving the highest scores, followed by Gemini (67.6 ± 4.5) and ChatGPT (63.1 ± 4.9) (P < 0.001). The median (interquartile range) mDISCERN scores were 2 (1) for ChatGPT, 3 (0) for Gemini, and 3 (1) for Llama (P < 0.001), indicating a significant difference in the quality of information provided by the different models.</p><p><strong>Conclusion: </strong>The three chatbots demonstrated statistically similar results in terms of readability. Llama achieved the highest EQIP score among them. Additionally, both Llama and Gemini outperformed ChatGPT in terms of mDISCERN scores.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669838","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}