International Urology and Nephrology最新文献

{"title":"Exploring the influencing factors of abdominal aortic calcification events in chronic kidney disease (CKD) and non-CKD patients based on interpretable machine learning methods.","authors":"Haowen Lin, Xiaoying Dong, Yuhe Yin, Qingqing Gao, Siqi Peng, Zewen Zhao, Sijia Li, Renwei Huang, Yiming Tao, Sichun Wen, Bohou Li, Qiong Wu, Ting Lin, Hao Dai, Feng Wen, Zhuo Li, Lixia Xu, Jianchao Ma, Zhonglin Feng, Shuangxin Liu","doi":"10.1007/s11255-025-04564-5","DOIUrl":"https://doi.org/10.1007/s11255-025-04564-5","url":null,"abstract":"<p><strong>Background: </strong>Calcification is prevalent in CKD patients, with abdominal aortic calcification (AAC) being a strong predictor of coronary calcification. We aimed to identify key calcification factors in CKD and non-CKD populations using machine learning models.</p><p><strong>Methods: </strong>Data from the National Health and Nutrition Examination Survey (NHANES), including demographics, blood and urine tests, and AAC scores, were analyzed using machine learning models. The Shapley additive explanations (SHAP) analysis was applied to interpret the models.</p><p><strong>Results: </strong>Among 505 CKD and 2,582 non-CKD participants, common key factors for calcification included age, estimated glomerular filtration rate (eGFR), smoking history, blood glucose levels (Glu), Ca*P and the urine albumin-to-creatinine ratio (UACR). Age, smoking history and eGFR were the top-ranking features in the model for both two groups. Inflammatory markers such as monocyte-to-lymphocyte ratio (MHR), monocyte-to-high-density lipoprotein ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) were more significant in CKD group. Trigger points for AAC events were identified: in CKD, eGFR of 90 mL/min/1.73 m², MHR values of 0.5 and 0.75, MLR values of 0.25, and SP of 120 mmHg; in non-CKD, eGFR of 105 mL/min/1.73 m², Ca*P values of 40, UACR values of 10, and TG of 200 mg/dL.</p><p><strong>Conclusions: </strong>Regardless of CKD status, age, smoking history, and eGFR are key determinants of calcification. In the CKD population, inflammatory markers are more significant than in the non-CKD group.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002606","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":"Comparative efficacy of expanded hemodialysis and online hemodiafiltration: a systematic review and meta-analysis.","authors":"Ozgur Aktas, Ruslan Akhmedullin, Anara Abbay, Arif E Narin, Muharrem S Yanilmaz, Candan Genc, Abduzhappar Gaipov, Adrian Covic, Mehmet Kanbay","doi":"10.1007/s11255-025-04559-2","DOIUrl":"https://doi.org/10.1007/s11255-025-04559-2","url":null,"abstract":"<p><strong>Background and aim: </strong>The comparison between online hemodiafiltration (online HDF) and expanded hemodialysis (HDx) remains undetermined. This systematic review and meta-analysis were conducted to provide comparative evidence on the molecule clearance, efficacy, and all-cause mortality of HDx versus online HDF in patients with end-stage kidney disease (ESKD).</p><p><strong>Materials and methods: </strong>A comprehensive search was conducted up to September 10, 2024, using various electronic databases PubMed, Cochrane Library, Scopus, Web of Science, and Ovid MEDLINE with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk ratios (RR) for binary outcomes and standardized mean differences (Hedge's g) were used for continuous outcomes.</p><p><strong>Results: </strong>The meta-analysis included eight studies, consisting of 614 patients in total. No statistical difference in all-cause mortality was found between HDx and online HDF (RR 0.97; 95% Cl 0.62-1.53, p = 0.91, I² = 0%). Online HDF revealed a decrease in β2-microglobulin clearance (Hedges's g = - 0.61, 95% CI - 1.04 to - 0.18, p = 0.01), with no differences in creatinine, phosphate, and urea clearance. Prolactin clearance favored online HDF (Hedge's g = - 1.49, 95% Cl - 3.36 to 0.37, p = 0.12) but the pooled estimate remained insignificant, with high heterogeneity (I² = 90.87%).</p><p><strong>Conclusion: </strong>Overall, both modalities are found to be effective, but online HDF revealed superior efficacy with potential advantages in middle-molecule clearance. Further standardized, randomized, and high-quality trials are required not only to confirm these findings but also to address the substantial heterogeneity found in the clearance of prolactin, myoglobulin, and albumin loss.</p><p><strong>Registration: </strong>PROSPERO registration number: CRD42024622632.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004804","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":"Association between serum spexin levels and diabetic nephropathy in patients with type 2 diabetes: a cross-sectional study.","authors":"Robab Aboutorabi, Golrokh Hariri, Aida Bakhshi, Majid Alizadeh, Hassan Mehrad-Majd","doi":"10.1007/s11255-025-04556-5","DOIUrl":"https://doi.org/10.1007/s11255-025-04556-5","url":null,"abstract":"<p><strong>Background: </strong>Diabetic nephropathy (DN) is a serious complication of diabetes, with a high prevalence ranging from 21.8% in China, 35.3% in African countries, and an overall prevalence of 20-40% worldwide. This study investigated serum spexin levels in patients with type 2 diabetes, comparing those with and without DN, and explored its association with metabolic parameters.</p><p><strong>Methods: </strong>This cross-sectional study was conducted among patients with type-2 diabetes according to ADA guidelines. After obtaining informed consent, urine albumin-to-creatinine-ratio (ACR) was determined and patients were categorized into two groups: with-nephropathy (ACR ≥ 30) and without-nephropathy (ACR < 30). The correlation between spexin and demographic, anthropometric, and biochemical variables was further determined. Logistic regression analysis was used to assess the relationship between spexin and the likelihood of DN. Receiver Operating Characteristic (ROC) curve analysis determined the optimal serum spexin cutoff for distinguishing between groups.</p><p><strong>Results: </strong>A total of 97 diabetic individuals (33 with DN, 64 without) participated in the study. Serum spexin was significantly lower in patients with DN compared to those without DN (p < 0.001). Spexin concentrations showed an inverse correlation with LDL and ACR levels. Lower spexin levels were associated with a reduced likelihood of DN (OR 0.46, 95% CI 0.31-0.69; p < 0.001). ROC curve analysis identified a cutoff value of 81.10 ng/ml, with an area under the curve of 0.986, demonstrating 95.3% sensitivity and 94.1% specificity for diagnosing DN.</p><p><strong>Conclusion: </strong>Lower serum spexin levels are associated with impaired kidney function, indicating its potential as a predictive biomarker for diabetic nephropathy. However, further validation in larger and more diverse cohorts is needed to address limitations such as sample size and unmeasured confounders.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063777","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 impact of pregnancy on mortality and graft outcomes in kidney transplant recipients: a systematic review and meta-analysis.","authors":"Mehmet Kanbay, Crischentian Brinza, Lasin Ozbek, Selen Unlu, Sama Mahmoud Abdel-Rahman, Mustafa Guldan, Ozgur Aktas, Andreea Covic, Alexandru Burlacu, Adrian Covic","doi":"10.1007/s11255-025-04572-5","DOIUrl":"https://doi.org/10.1007/s11255-025-04572-5","url":null,"abstract":"<p><strong>Background and aim: </strong>Pregnancy in kidney transplant recipients involves complex physiological changes that could potentially impact long-term graft function and survival. Despite some evidence suggesting minimal long-term effects on graft survival, conflicting results on graft function and timing-related risks highlight the need for a comprehensive review. This systematic review and meta-analysis aims to evaluate long-term impact of pregnancy on patient survival, graft failure, serum creatinine levels, estimated glomerular filtration rate (eGFR), and proteinuria in kidney transplant recipients.</p><p><strong>Materials and methods: </strong>We conducted a systematic review and meta-analysis adhering to PRISMA guidelines and registered with PROSPERO (CRD42024569702). We searched PubMed, Scopus, Web of Science, Cochrane Library, and Ovid MEDLINE. Studies were eligible if they provided data on adult kidney transplant recipients (> 18 years) who became pregnant post-transplant and included a control group of non-pregnant or non-conceived individuals.</p><p><strong>Results: </strong>Among the 6118 results screened, 19 studies met the eligibility criteria and were included in the meta-analysis. The risk of allograft failure or graft loss was similar between pregnant and non-pregnant controls (OR 1.13, 95% CI 0.83-1.53, p = 0.43), with a slightly higher adverse outcome rate in pregnant patients (25.4 vs. 19.8%). All-cause mortality risk was also comparable (OR 0.63, 95% CI 0.38-1.07, p = 0.09), with low heterogeneity (I² = 12%). Creatinine levels were significantly lower before pregnancy compared to after delivery (SMD - 0.33, 95% CI - 0.52 to - 0.14, p = 0.0008).</p><p><strong>Conclusion: </strong>Pregnancy in kidney transplant recipients leads to increased creatinine levels in postpartum but does not significantly affect long-term graft survival. While creatinine levels generally decrease during pregnancy, they show variability by trimester. The risk of allograft failure and mortality is similar between pregnant and non-pregnant recipients though adverse outcomes are slightly more frequent in pregnant patients, emphasizing the need for an optimal follow-up protocol of pregnant transplant recipients that takes trimester-specific graft function variations into consideration and that establishes clear thresholds for further evaluation and timely intervention.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009564","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":"Endoscopic en bloc prostate enucleation: a propensity score matched analysis between greenlight enucleation of prostate (GreenLEP) vs holmium laser enucleation of prostate (HOLEP) outcomes and safety with a 12-month follow-up.","authors":"Simone Morselli, De Rienzo Gaetano, Ditonno Pasquale, Ferrari Sergio, Lucarelli Giuseppe, Spilotros Marco, Zaraca Carlo, Greco Piergiorgio, Rabito Salvatore, Micali Salvatore, Ferrari Riccardo, Toso Stefano, Gatti Lorenzo, Ferrari Giovanni, Luca Cindolo","doi":"10.1007/s11255-025-04543-w","DOIUrl":"https://doi.org/10.1007/s11255-025-04543-w","url":null,"abstract":"<p><strong>Purpose: </strong>Greenlight has been successfully used to treat BPH since 2010s; however, its role during GreenLEP is still under investigation, differently from holmium in HOLEP. Study aim is to compare GreenLEP and HOLEP.</p><p><strong>Methods: </strong>Data for GreenLEP and HOLEP were prospectively collected in two referral centers since 2021. Outcomes and safety were compared through propensity score matching. All patients had at least 12-month follow-up.</p><p><strong>Results: </strong>A total of 120 patient who underwent GreenLEP and 115 HOLEP were enrolled. At unmatched comparison, median PSA and age were comparable, as well as prostate volume, with a median of 98.5 (IQR 82.0-130.0)ml and 90.0 (IQR 65.0-115.0)ml, respectively; on the contrary, IPSS (p = 0.013) and indwelling catheter rate (p =  < 0.001) were higher in HOLEP group. Moreover, safety and functional outcomes were comparable, besides lower PSA and IPSS were found at 12-month follow-up in HOLEP group (p < 0.001). Using propensity score matching on 56 GreenLEP and 56 HOLEP, the groups were comparable for age, prostate volume, PSA, ongoing anticoagulant and anti-aggregant therapy, ongoing BPH therapy, pre-operative hemoglobin values, indwelling catheter presence, and IPSS. Regarding outcomes, they were all comparable except lower IPSS and PSA at 6- and 12-month follow-up for HOLEP. Conversely, late complications and stress incontinence were higher in HOLEP (1.8% vs 16.1%, p = 0.008), but at multivariate analysis, there was no significant difference.</p><p><strong>Conclusion: </strong>According to our results, both HOLEP and GreenLEP are effective in treating BPH in large prostates. However, HOLEP provided slightly better IPSS and PSA reduction, while GreenLEP demonstrated fewer late complications. Further randomized clinical trials are mandatory.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990380","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":"Prospective analysis of the morcellation efficiency of a novel device (MultiCut®) for prostate laser enucleation.","authors":"Borja García-Gómez, Javier Gil-Moradillo, Ignacio Sola-Galarza, Alfonso Gimeno-Collado, Lucía García-González, Antonio Fidel Campoy-Pérez, Amparo Andrés-Ramos, Alfredo Rodríguez-Antolín","doi":"10.1007/s11255-025-04568-1","DOIUrl":"https://doi.org/10.1007/s11255-025-04568-1","url":null,"abstract":"<p><strong>Objective: </strong>To assess the efficiency and safety of the MultiCut Solo® morcellator in patients undergoing holmium laser enucleation of the prostate (HoLEP), and to analyze the influence of device settings, surgeon experience, and blade reuse on morcellation outcomes.</p><p><strong>Methods: </strong>This prospective, multicenter, observational study included 232 patients undergoing HoLEP from January to September 2023 across two high-volume centers in Madrid, Spain. Three morcellation settings were evaluated: reduction, fast, and slow modes. Data on morcellation efficiency (g/min), surgeon experience (expert vs. trainee), and blade use frequency (0-10) were collected. Efficiency and complication rates were compared across groups. Statistical analysis was performed using Student's t-tests and Pearson's correlation.</p><p><strong>Results: </strong>A total of 326 morcellation instances were analyzed. Mean global morcellation efficiency was 14.5 g/min (SD ± 7.6), with reduction, fast, and slow modes yielding 16.7, 12.5, and 8.5 g/min, respectively. Surgeons' experience showed a non-significant trend toward higher efficiency (15.2 vs. 13.1 g/min, p = 0.051). Blade reuse up to 10 times did not significantly affect performance. Bladder perforation occurred in 1.29% of cases, and hematuria requiring temporary morcellation suspension in 3.88%. Obstruction occurred in 31.47% of cases, but disassembly was only required in 8.19%.</p><p><strong>Conclusions: </strong>The MultiCut Solo® morcellator demonstrated high efficiency and a favorable safety profile. Efficiency was consistent across surgeon experience levels and was not significantly impacted by blade reuse within the manufacturer's recommended lifespan. These findings suggest that the device is effective and user-friendly, even in the early learning curve, and represents a valuable tool for tissue morcellation in HoLEP procedures.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995980","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":"Metformin attenuates endoplasmic reticulum stress in diabetic kidney disease: mechanistic insights and future perspectives.","authors":"Huang Bin, Wenjie Wen","doi":"10.1007/s11255-025-04562-7","DOIUrl":"https://doi.org/10.1007/s11255-025-04562-7","url":null,"abstract":"<p><p>Diabetic kidney disease (DKD) is a common microvascular complication of diabetes that can lead to end-stage renal failure. Emerging evidence suggests that endoplasmic reticulum (ER) stress plays a crucial role in the pathogenesis of DKD by affecting various renal parenchymal cells, including endothelial cells, podocytes, and mesangial cells. This review comprehensively examines the relationship between ER stress and DKD, focusing on how metformin, a first-line antidiabetic medication, ameliorates ER stress-induced kidney injury. Multiple factors, including reactive oxygen species (ROS), proteinuria, and advanced glycation end products (AGEs), contribute to ER stress in DKD. Metformin's renoprotective effects are primarily mediated through activation of the AMPK signaling pathway, which modulates ER stress response, reduction of oxidative stress and its impact on ER function, and improvement of mitochondrial function. These mechanisms collectively lead to decreased proteinuria, reduced cell apoptosis, and attenuated epithelial-mesenchymal transition in diabetic kidneys. Understanding these molecular mechanisms provides new insights into the therapeutic potential of metformin in DKD treatment. However, further research is needed to elucidate the precise molecular pathways through which metformin regulates ER stress in different renal cell types under diabetic conditions.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002781","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 mortality risk in US adults with a history of kidney stones: results from NHANES III with over 30 years of follow-up.","authors":"Ben H Chew, Samir Bhattacharyya, Larry E Miller, Steffi K K Yuen, Thomas Tailly, Vineet Gauhar, Naeem Bhojani","doi":"10.1007/s11255-025-04570-7","DOIUrl":"https://doi.org/10.1007/s11255-025-04570-7","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between a history of kidney stones and long-term all-cause and cause-specific mortality in a nationally representative sample of US adults.</p><p><strong>Methods: </strong>This observational study included adults who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Kidney stone history was self-reported during the survey. Vital status and causes of death during follow-up were ascertained via the National Death Index through December 31, 2019. Weighted Cox proportional hazards models estimated hazard ratios (HRs) for the association between kidney stone history and all-cause, cardiovascular, cancer, and renal mortality. Models were progressively adjusted for demographic, socioeconomic, and clinical variables to account for confounding factors.</p><p><strong>Results: </strong>The final analytic sample comprised 19,578 participants (weighted kidney stone prevalence = 5.3%) with 420,947 person-years of follow-up (range: 0-31 years). Stone formers were older than non-stone formers (mean age 54 vs. 43 years) with a higher prevalence of comorbidities. In the unadjusted model, kidney stone history was associated with increased all-cause mortality risk (HR = 1.82; 95% CI 1.63-2.03). However, this association was attenuated in the fully adjusted model (HR = 0.89; 95% CI 0.79-1.01). No significant differences were observed between groups for cardiovascular (HR = 0.87; 95% CI 0.73-1.03), cancer (HR = 1.01; 95% CI 0.74-1.37), or renal mortality (HR = 0.99; 95% CI 0.31-3.16) in fully adjusted models.</p><p><strong>Conclusion: </strong>In this nationally representative cohort of US adults, a history of kidney stones was not associated with an increased risk of all-cause or cause-specific mortality after adjustment for confounders.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019825","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":"Flexible suction ureteral access sheaths vs. sheathless RIRS for renal and proximal ureteral stones: a comparative study.","authors":"Qiang Liu, Ting Zeng, Shuxia Zhu","doi":"10.1007/s11255-025-04565-4","DOIUrl":"https://doi.org/10.1007/s11255-025-04565-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the efficacy and safety of flexible and navigable suction ureteral access sheath (FANS)-assisted retrograde intrarenal surgery (RIRS) vs. sheathless techniques in treating renal/proximal ureteral stones, with a focus on immediate and short-term stone clearance rates, stenting duration, and complications.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on 115 patients (FANS group: 73; control group: 42) with comparable mean stone diameters (FANS: 14.1 ± 5.4 mm vs. control: 12.2 ± 4.9 mm, P = 0.06). Outcomes assessed included immediate (postoperative day 1) and 1-month stone-free rates (SFRs), operative time, ureteral stenting duration, and complications.</p><p><strong>Results: </strong>The FANS group demonstrated a significantly higher immediate SFR (84.9% vs. 69.0%, P < 0.05), while the 1-month SFRs were comparable (91.8% vs. 90.5%). Despite longer operative times (51 vs. 40 min, P < 0.05), the FANS group had a shorter stenting duration (12 vs. 21 days, P < 0.05). Complication rates were similar (FANS: 11.0% vs. control: 11.9%), with no ureteral injuries in either group.</p><p><strong>Conclusions: </strong>FANS-assisted RIRS demonstrated superior immediate stone clearance compared to sheathless RIRS, which may be particularly advantageous for managing complex or infected stones, where complete initial clearance is clinically paramount. In addition, the significantly shorter stenting duration with FANS offers distinct benefits for stent-intolerant patients. While both techniques achieved similar 1-month stone-free rates, these advantages position FANS as a valuable option for selected patients based on stone characteristics and individual clinical priorities. Further studies should explore long-term outcomes and cost-effectiveness.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965486","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":"Analysis of gray zone PSA and PSAD correlated with PIRADS v2.1 in the MRI-US fusion prostate biopsy era: a retrospective bi-centre study.","authors":"Michelangelo S Cobangbang, Bryian P Paner, Jerome Kyle R San Jose, Miguel Antonio D Isada, Paul Anthony L Sunga","doi":"10.1007/s11255-025-04551-w","DOIUrl":"https://doi.org/10.1007/s11255-025-04551-w","url":null,"abstract":"<p><strong>Background: </strong>Multiple parameters including PSA, PSAD, and PIRADS v2.1 score, are being associated in an effort to increase the overall detection rate of clinically significant prostate cancer (csPCa). This study aims to explore gray zone PSA and PSAD correlated with PIRADS score in the detection of csPCa using MRI-US fusion prostate biopsy.</p><p><strong>Methods: </strong>Men with PSA of 4-10 who underwent prostate multiparametric MRI of the prostate (mpMRI) were divided into two groups (4-< 7 and ≥ 7-10 ng/mL) and according to PSA density (< 0.10, 0.10-0.20 and > 0.20). Subgroups according to PIRADS score were made for each group. Chi-square test was utilized for analysing the comparison of histopathology results between the PSA and PSA density subgroups per PIRADS lesion category. Using receiver-operating characteristic (ROC) curves, the diagnostic accuracy of PSA and PSAD in identifying csPCa were evaluated, and the best cutoff values were identified.</p><p><strong>Results: </strong>Overall detection rate of csPCa was 40.4% (146/361) in the cohort of men with gray zone PSA value. Clinically significant difference in csPCa detection rate was observed in the PSAD subgroups (p =  < 0.001) while no significant difference was observed in the two groups of PSA (p = 0.387). On subgroup analysis, only the PSAD subcategories of PIRADS 4 and 5 showed significant difference (p = 0.028 and p = 0.003, respectively). Based on the ROC curve, the optimal cutoff for PSA was 6.32 with sensitivity and specificity of 65.1% and 43.3%, respectively [AUC 0.54 (0.48-0.60)]. PSAD optimal cutoff was 0.139 with sensitivity and specificity of 80.8% and 49.3%, respectively [AUC 0.67 (0.61-0.72)].</p><p><strong>Conclusions: </strong>PSA and PSAD combined with PIRADS v2.1 provide more diagnostic value than when used alone and can be used to counsel men who will undergo MRI-US fusion biopsy. In the gray zone, PSAD is a more reliable diagnostic predictor of csPCa than PSA.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001104","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}