Investigative and Clinical Urology最新文献

{"title":"Surgical management of vesicourethral anastomotic stenosis.","authors":"Marie-Therese Valovska, Tarah Woodle, Judith C Hagedorn","doi":"10.4111/icu.20250105","DOIUrl":"10.4111/icu.20250105","url":null,"abstract":"<p><p>Vesicourethral anastomotic stenosis (VUAS) is a challenging complication following radical prostatectomy with incidence ranging between, and sometimes exceeding, 1.4%-4.8%. While endoscopic management remains the first-line approach, refractory cases often necessitate open or robotic reconstruction. This review examines contemporary surgical options, including newer reconstructive techniques and salvage procedures for recalcitrant stenoses. A comprehensive review of all relevant literature was conducted to evaluate surgical options for VUAS. Techniques assessed included endoscopic procedures, YV- and T-plasty, transvesical reconstruction, robotic-assisted approaches, and salvage techniques such as bladder flaps and intestinal substitution. A novel endoscopic procedure, the transurethral incision with transverse mucosal realignment, may offer higher success with decreased morbidity. Open and robotic techniques are often utilized in recalcitrant stenosis. The most comprehensive cohort to date looking at robotic repair of refractory VUAS by the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) demonstrated a 75% success rate at 3 months. Patients with a history of radiation may suffer from higher complication rates. Salvage options, including intestinal substitution for extensive stenoses, have been described but remain a last resort due to potential for greater morbidity. Urinary diversion is an option for patients with refractory disease, often leading to improved quality of life despite initial hesitancy. The management of VUAS requires an individualized approach based on degree of stenosis, prior treatments, and patient goals. While newer techniques such as robotic reconstruction show promise, long-term studies are needed to determine their efficacy and complication rates. Continued advancements will refine treatment algorithms for this complex condition.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"383-394"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of neoadjuvant chemotherapy on survival outcomes subsequent to radical cystectomy in pathological T0 bladder cancer patients: A multicenter large-scale analysis.","authors":"Jong Ho Park, Sangchul Lee, Seung-Hwan Jeong, Ja Hyeon Ku, Kyung Hwan Kim, Jong Kil Nam, Bumjin Lim, Bum Sik Hong, Wook Nam, Sung Gu Kang, Seok Ho Kang, Tae Gyun Kwon, Tae-Hwan Kim, Jieun Heo, Won Sik Ham, Geehyun Song, Ho Kyung Seo, Wan Song, Hyun Hwan Sung, Byong Chang Jeong, Jong Jin Oh","doi":"10.4111/icu.20250165","DOIUrl":"10.4111/icu.20250165","url":null,"abstract":"<p><strong>Purpose: </strong>After radical cystectomy (RC), the pathologic complete response (pT0) among muscle-invasive bladder cancer (MIBC) is considered a favorable oncological result. The objective of this study was to evaluate the effect of neoadjuvant chemotherapy (NAC) among the pT0 patients using a large-scale multicenter study.</p><p><strong>Materials and methods: </strong>This study included 3,972 patients who underwent RC at 11 tertiary medical centers. Analysis was conducted on patients with MIBC who achieved a pT0, with a focus on comparing results between those who received NAC and those who did not. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed in these groups.</p><p><strong>Results: </strong>Among 252 eligible pT0 patients, 121 were categorized in the non-NAC group while the remaining 131 were in the NAC group. As compared to the non-NAC group, the NAC group demonstrated significantly better survival outcomes, with 5-year RFS rates of 89% vs. 80% (p=0.043), OS rates of 84% vs. 69% (p=0.011), and CSS rates of 95% vs. 80% (p=0.007). Multivariable Cox proportional hazards analyses demonstrated that NAC independently improved RFS (hazard ratio [HR] 0.192, p=0.002) and CSS (HR 0.200, p=0.020), but not OS (HR 0.672, p=0.263).</p><p><strong>Conclusions: </strong>In patients with MIBC who achieved a pT0, NAC administration prior to RC has a positive impact on oncological prognosis. Although further prospective studies are needed for validation, the results of this study will confirm the importance of NAC in MIBC.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"395-404"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial resistance of <i>Mycoplasma genitalium</i> in Korea for two decades.","authors":"Gilho Lee, Heeyoon Park, Yumi Seo, Seung-Ju Lee","doi":"10.4111/icu.20250106","DOIUrl":"10.4111/icu.20250106","url":null,"abstract":"<p><strong>Purpose: </strong>Antimicrobial-resistant (AMR) <i>Mycoplasma genitalium</i> has become a global concern. To assess AMR patterns in Korea, we analyzed the genetic diversity of the AMR-determining sites (ARDS) in <i>M. genitalium</i> across in 285 samples collected over two decades.</p><p><strong>Materials and methods: </strong><i>Mycoplasma</i>-positive samples were collected from various groups: males at one referral center (ORC) from 2014 to 2019 (G1; 43) and from 2020 to 2023 (G2; 54), males at primary care clinics (PCCs) in 2018-2019 (G3; 84), female sex workers at a regional healthcare center in 2004 (G4; 51), and females at PCCs in 2018-2019 (G5; 53). Sanger sequencing was performed at positions 2058/2059 in the 23S rRNA gene and positions GyrA95, GyrA99, ParC83, and ParC87 of topoisomerase IV genes in <i>M. genitalium</i>.</p><p><strong>Results: </strong>In 2004, mutations were rare with S83I (0.0%), M95I (3.4%), and A2059G (10.5%). By 2020-2023, ARDS mutations had become common, peaking at S83I (83.3%) and A2059G (70.4%). No sex differences were observed in ARDS mutations between G3 and G5. A comparison of mutations in males at the ORC showed significant differences in A2059G and S83I between pre-2020 (G1) and post-2020 (G2). Males at the ORC (G1) had higher mutation rates in A2059G, GyrA95, and GyrA99 compared to males at PCCs (G3).</p><p><strong>Conclusions: </strong>Currently, referred males exhibit a rapid increase in AMR, and the synergy between A2059G and S83I/R/N mutations raises concerns regarding the emergence of pan-drug-resistant <i>M. genitalium</i>, potentially leading to an irreversible crisis in treatment options in Korea.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"455-461"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing consensus recommendations for metastatic hormone-sensitive prostate cancer in South Korea: A modified Delphi study.","authors":"Jae Young Joung, In Gab Jeong, Sung Gu Kang, Young Hwii Ko, Kyo Chul Koo, Kwang Hyun Kim, Myung Ki Kim, Soodong Kim, Jeong Hyun Kim, Sung-Woo Park, Jae Young Park, Wan Song, Seung Hwan Lee, Seung Il Jung, Jae Hoon Chung, Chang Wook Jeong, Kwan Joong Joo, Seock Hwan Choi, Se Young Choi, Seol Ho Choo, Hong Koo Ha, Sung Kyu Hong, Sung-Hoo Hong, Jeong Hee Hong, Jun Hyuk Hong, Sun Il Kim, Cheol Kwak, Seong Soo Jeon","doi":"10.4111/icu.20250147","DOIUrl":"10.4111/icu.20250147","url":null,"abstract":"<p><strong>Purpose: </strong>Consensus is lacking among South Korean urologists on the appropriate treatment of metastatic hormone-sensitive prostate cancer (mHSPC). A modified, Delphi-based consensus on managing mHSPC patients was developed to support clinical decision-making.</p><p><strong>Materials and methods: </strong>Thirty-six questions on mHSPC treatment were developed by an expert committee (five urologists). Nine questions required achievement of consensus (key questions). Twenty-three urologists participated in two rounds of a Delphi survey. Consensus was defined as ≥75% agreement among panelists, with ≥90% agreement representing strong consensus.</p><p><strong>Results: </strong>Eighteen questions (50.0%) reached strong consensus, 15 (41.7%) reached consensus, and three (8.3%) reached no consensus. Eight key questions (88.9%) reached strong consensus and one (11.1%) reached consensus. Consensus was reached on recommending androgen-deprivation therapy (ADT) intensification, irrespective of disease volume or type, with an androgen receptor pathway inhibitor (ARPI) as the preferred option. Not using docetaxel alone with ADT when an ARPI is available for treatment intensification was recommended (strong consensus). For high-volume mHSPC patients with a pathogenic, speckle-type poxvirus and zinc finger protein mutation, ADT+ARPI was recommended over triplet therapy (strong consensus). Panelists recommended regular imaging every 6-12 months if no ARPI reimbursement restrictions exist, but a 3-month interval (per current reimbursement guidelines) otherwise. ADT+ARPI was the most recommended systemic treatment (strong consensus).</p><p><strong>Conclusions: </strong>This Delphi consensus established local consensus on controversial areas of mHSPC management. The findings offer meaningful perspectives that may help shape future treatment strategies and encourage thoughtful reconsideration of reimbursement criteria to align evidence and clinical practice in South Korea.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"416-430"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum: Correction of the Funding. Animal models of bone metastatic prostate cancer.","authors":"Jong Hyun Tae, In Ho Chang","doi":"10.4111/icu.20230026c","DOIUrl":"10.4111/icu.20230026c","url":null,"abstract":"<p><p>This corrects the article on p. 219 in vol. 64, PMID: 37341002.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"469"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aquablation versus HoLEP: Propensity score matching analysis of functional outcomes and ejaculation preservation.","authors":"Kyung Tak Oh, Jang Hwan Kim","doi":"10.4111/icu.20250055","DOIUrl":"10.4111/icu.20250055","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the clinical outcomes of Aquablation and Holmium Laser Enucleation of the Prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH), with emphasis on functional improvement, ejaculatory preservation, and perioperative safety.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed data from January 2023 to March 2024, excluding patients with follow-up shorter than 3 months. Propensity score matching was performed using age, prostate volume, and preoperative prostate-specific antigen (PSA). Pre- and postoperative outcomes included International Prostate Symptom Score, Overactive Bladder Symptom Score, maximum flow rate (Qmax), post-void residual urine volume (PVR), PSA, and MSHQ-EjD (Male Sexual Health Questionnaire-Ejaculatory Dysfunction)-based ejaculatory grading (0-3). Paired t-tests, Wilcoxon signed-rank tests, McNemar's test, and Mann-Whitney U test were applied as appropriate.</p><p><strong>Results: </strong>A total of 104 patients were included, with 34 matched pairs. Both procedures significantly improved lower urinary tract symptoms, with no significant differences in symptom score changes or PVR. HoLEP resulted in greater improvements in Qmax and PSA (p=0.011 and p<0.001, respectively). Aquablation demonstrated significantly better preservation of ejaculation (p=0.002). Although transient incontinence was more frequent in HoLEP and gross hematuria and urinary retention were more common in Aquablation, none of the complication rates showed statistically significant differences.</p><p><strong>Conclusions: </strong>Aquablation and HoLEP are both effective surgical options for BPH. Aquablation offers comparable symptom relief with significantly superior ejaculation preservation, making it particularly suitable for sexually active patients. HoLEP provides greater deobstructive efficacy, as evidenced by superior Qmax and PSA outcomes. These findings support individualized, patient-centered decision-making.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"431-438"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary management of metastatic urothelial carcinoma.","authors":"Jong Jin Oh, Sung Kyu Hong","doi":"10.4111/icu.20250008","DOIUrl":"10.4111/icu.20250008","url":null,"abstract":"<p><p>Urothelial carcinoma, the most common malignancy of the urinary tract, presents a significant challenge, particularly in its metastatic stage, where prognosis remains poor despite advancements in treatment. Historically, platinum-based chemotherapy has been the standard first-line therapy, achieving moderate response rates but limited long-term survival. Recent breakthroughs have introduced immune checkpoint inhibitors, antibody-drug conjugates (ADCs), and targeted therapies as more effective alternatives. Enfortumab vedotin plus pembrolizumab has demonstrated superior efficacy as a first-line treatment, improving overall survival (OS) and objective response rates compared to chemotherapy. Maintenance therapy with avelumab has further prolonged survival in patients responding to initial platinum-based chemotherapy. Additionally, sacituzumab govitecan, an ADC targeting Trop-2, and erdafitinib, a fibroblast growth factor receptor (FGFR) inhibitor, have provided promising options for patients with refractory disease or FGFR alterations. The evolving treatment paradigm now prioritizes biomarker-driven, personalized approaches over traditional chemotherapy-based regimens. However, challenges remain in optimizing treatment sequencing and managing toxicity. Future research should focus on refining patient selection criteria and exploring novel combination therapies to enhance efficacy and durability of response.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"375-382"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of bladder outlet obstruction on age-related changes in male bladder contractility.","authors":"Jin Bong Choi, Kang Jun Cho, Joon Chul Kim, Young Kyu Han, Ju Hun Ahn, Seong Joo Yang, Jun Sung Koh","doi":"10.4111/icu.20250161","DOIUrl":"10.4111/icu.20250161","url":null,"abstract":"<p><strong>Purpose: </strong>Changes in bladder contractility due to aging are among the important causes of lower urinary tract symptoms (LUTS) in elderly males. The purpose of this study was to observe changes in bladder contractility due to aging in male patients taking medications commonly used to treat LUTS in clinical practice.</p><p><strong>Materials and methods: </strong>Male patients aged over 40 years who underwent urodynamic studies for LUTS from January 2012 to December 2024 were included. The bladder outlet obstruction (BOO) index was used to distinguish between males with BOO and those without BOO. Changes in bladder contractility according to age in each group were analyzed using the bladder contractility index. The Pearson correlation coefficient (<i>r</i>) was used to calculate the strength of the linear relationship between age and the variables.</p><p><strong>Results: </strong>A total of 449 male patients who underwent urodynamic studies for LUTS were eligible for this study (311 in the BOO group and 138 in the BOO group). Age and the maximum flow rate were inversely related in both groups. Age and bladder contractility were significantly correlated in the non-BOO group (p=0.021) but not in the BOO group (p=0.057).</p><p><strong>Conclusions: </strong>This study revealed that BOO might act as a confounding variable in measuring the contractility of an aged bladder. Excluding the effect of BOO, bladder contractility significantly decreases with age. Therefore, when male LUTS are treated, changes in bladder contractility due to aging vary depending on BOO.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"462-468"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between truncal muscle mass index measured by bioelectrical impedance analysis and overactive bladder symptoms in men: A retrospective cross-sectional analysis.","authors":"Hoyoung Bae, Jung Hoon Lee, Min Chul Cho, Hwancheol Son, Hyeon Jeong, Sangjun Yoo","doi":"10.4111/icu.20250205","DOIUrl":"10.4111/icu.20250205","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the relationship between truncal muscle mass, particularly the skeletal truncal muscle mass index (sTMI), and overactive bladder (OAB) symptoms in adult men, using bioelectrical impedance analysis (BIA).</p><p><strong>Materials and methods: </strong>We retrospectively analyzed health screening data from 5,475 men aged ≥40 years collected between 2014 and 2022. OAB was defined as an OAB Symptom Score (OABSS) ≥3 and urgency score ≥2, with moderate-to-severe OAB defined as OABSS ≥6 and urgency score ≥2. Body composition metrics, including fat-free mass (FFM), total muscle mass (TMM), and truncal muscle mass (whole and skeletal), were measured via BIA. The sTMI was calculated by dividing skeletal truncal muscle mass by body mass index (BMI). Logistic regression and receiver operating characteristic (ROC) analyses were conducted to assess predictors of OAB.</p><p><strong>Results: </strong>The overall OAB prevalence was 10.6%. In univariate analysis, FFM (odds ratio [OR] 0.983, p=0.013), TMM (OR 0.982, p=0.010), and sTMI (OR 0.447, p=0.025) were inversely associated with OAB symptoms. However, in multivariate analysis, only sTMI remained a significant independent predictor of moderate-to-severe OAB (OR 0.486, p=0.036). ROC analysis showed that sTMI had better predictive performance for severe OAB (area under the curve [AUC] 0.721) compared to age (AUC 0.706).</p><p><strong>Conclusions: </strong>sTMI, a BIA-based index reflecting truncal skeletal muscle normalized to BMI, is an independent predictor of moderate-to-severe OAB in men. This suggests a potential role of muscle composition in OAB pathophysiology and risk stratification.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"439-447"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancement of inter-/intra-reader agreement using the Prostate Imaging Reporting and Data System version 2.1 for prostate cancer detection in magnetic resonance imaging/transrectal ultrasound software fusion prostate biopsy.","authors":"Won Hoon Song, Tae Un Kim, Hwa Seong Ryu, Mi Sook Yun, Sung-Woo Park","doi":"10.4111/icu.20250208","DOIUrl":"10.4111/icu.20250208","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated inter-/intra-reader agreement with the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 to improve the detection rate of prostate cancer.</p><p><strong>Materials and methods: </strong>We enrolled 210 patients who underwent multiparametric magnetic resonance imaging (mpMRI) for clinically suspected or diagnosed prostate cancer. Four readers, including two urologists, viewed patients' mpMRI and scored PI-RADS between two sessions, including the time for feedback and training after the first reading session. Inter- and intra-reader agreements were evaluated using Fleiss' kappa coefficient (κ), agreement coefficient 1 (AC1), and percentage of agreement (PA).</p><p><strong>Results: </strong>The overall inter-reader agreement between all readers was moderate (κ=0.466, AC1=0.522, and PA=0.610). The overall inter-reader agreement improved in the second session. The agreement for peripheral zone (PZ) lesions was higher than that for transitional zone (TZ) lesions. At a PI-RADS cut-off of 4, the agreement for PZ lesions was almost perfect (PA=0.888) and higher than that for TZ lesions. The inter-reader agreement for lesions with a PI-RADS ≥4 and Gleason score ≥7 was almost perfect (AC1=0.960 and PA=0.964). The intra-reader agreement for lesions overall and PI-RADS ≥4 lesions were substantial (AC1=0.601) and almost perfect (PA=0.876), respectively.</p><p><strong>Conclusions: </strong>Readers achieved moderate agreement for PI-RADS version 2.1 and benefitted from training sessions. Feedback, training, and multidisciplinary discussions also improved inter-reader agreement. Our study can provide guidance, updates, and further steps for the standardization and improvement of PI-RADS scoring.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 5","pages":"405-415"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}