Investigative and Clinical Urology最新文献

{"title":"Warm coupling fluid reduces pain during extracorporeal shock wave lithotripsy without compromising stone fragmentation: A prospective controlled study.","authors":"Ahmet Murat Bayraktar, Onur Küçüktopçu, Bilgi İşler, Burak Yılmaz, Mustafa Bilal Hamarat","doi":"10.4111/icu.20260204","DOIUrl":"https://doi.org/10.4111/icu.20260204","url":null,"abstract":"<p><strong>Purpose: </strong>Pain during extracorporeal shock wave lithotripsy (ESWL) adversely affects compliance and outcomes. Evidence on the impact of coupling fluid temperature on pain is scarce. We evaluated the effect of coupling fluid temperature on pain and fragmentation efficacy.</p><p><strong>Materials and methods: </strong>This prospective non-randomized controlled study included 368 patients who underwent ESWL at a tertiary urology clinic between July 2023 and December 2025. Patients were allocated into two groups: warm coupling fluid (WCF) (38℃-42℃, n=113) and room-temperature coupling fluid (RCF) (n=255). All procedures were performed using an electromagnetic lithotripter. Outcomes were visual analog scale (VAS) pain score (primary) and stone fragmentation success (secondary).</p><p><strong>Results: </strong>The VAS score was significantly lower in the WCF group (4.00±1.34 vs. 5.37±2.01, p<0.001). No patients in the WCF group reported very severe pain (VAS ≥8), whereas the rate was 20.8% (53/255) in the RCF group (p<0.001). Fragmentation success rates were similar between groups (54.0% [61/113] vs. 58.4% [149/255], p=0.426). In ordinal logistic regression, RCF was associated with higher odds of more severe pain (odds ratio 4.010, 95% confidence interval 2.590-6.208, p<0.001).</p><p><strong>Conclusions: </strong>WCF significantly reduced procedural pain during ESWL without compromising fragmentation, and this effect was robust across propensity score-based sensitivity analyses. Given its low cost and ease of application, it represents a promising non-pharmacological adjunct in ESWL. Future randomized sham-controlled studies are warranted.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"554-561"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From empirical to targeted therapy: A comprehensive review of clinical microbiological diagnostics for urinary tract infections.","authors":"Jung-Ah Kim, Jae Heon Kim","doi":"10.4111/icu.20260348","DOIUrl":"https://doi.org/10.4111/icu.20260348","url":null,"abstract":"<p><p>Urinary tract infection (UTI) is a prevalent bacterial infection worldwide, complicated by high recurrence rates and increasing antimicrobial resistance (AMR). The elevated resistance rates to empirical therapies, particularly among Enterobacterales, emphasize the necessity for accurate and timely microbiological diagnostics. This review provides a comprehensive overview of the clinical microbiological diagnostic workflow for UTIs. We outline the sequential procedures from specimen collection, traditional Gram staining, and quantitative urine culture to modern identification methods, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), biochemical assays, direct MALDI-TOF MS, and multilocus sequence typing. Furthermore, we summarize the principles of diverse antimicrobial susceptibility testing (AST) methods, ranging from standard broth microdilution to automated AST systems and diffusion tests, alongside recent advances in genotypic AMR detection using multiplex polymerase chain reaction and next-generation sequencing. The complementary application of conventional phenotypic tests and rapid molecular diagnostics provides a practical clinical basis for accelerating the transition from empirical to targeted therapy. The systematic implementation of these diagnostic pipelines enhances the effectiveness of antimicrobial stewardship programs and reduces unnecessary exposure to broad-spectrum antimicrobials in clinical settings with growing multidrug-resistant pathogens. Moving forward, the continuous advancement of diagnostic techniques and the integrated interpretation of genotypic and phenotypic data will strengthen the scientific foundation for implementing precision medicine in UTI management.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"518-529"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: Urinary tract infections after benign cystectomy: Incidence, risk factors, pathogens, and resistance patterns.","authors":"Ghulam Fatima, Rekha Kumari, Rahila Shafoor, Abeera Saleem Mughal","doi":"10.4111/icu.20260337","DOIUrl":"https://doi.org/10.4111/icu.20260337","url":null,"abstract":"","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"608-611"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A turning point in the prostate-specific antigen screening debate: Insights from the 2026 Cochrane update and implications for clinical guidelines.","authors":"Eu Chang Hwang, Juan Victor Ariel Franco, Jae Hung Jung, Philipp Dahm","doi":"10.4111/icu.20260392","DOIUrl":"https://doi.org/10.4111/icu.20260392","url":null,"abstract":"","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"503-505"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the sex ratio at birth during the COVID-19 pandemic in South Korea: A population-based ecological time-series analysis.","authors":"Jae Yong Jeong, Young Joon Moon, Dong Hyuk Kang, Hae Do Jung, Lawrence Kim, Joo Yong Lee","doi":"10.4111/icu.20260113","DOIUrl":"https://doi.org/10.4111/icu.20260113","url":null,"abstract":"<p><strong>Purpose: </strong>The sex ratio at birth (SRB) is a biological indicator known to fluctuate under societal stressors. This study evaluated temporal changes in South Korea's SRB during the coronavirus disease 2019 (COVID-19) pandemic, exploring whether the timing of the shift aligned with periconceptional influences (e.g., severe stress impacting paternal sperm viability), with particular focus on Daegu, the initial epicenter of the outbreak.</p><p><strong>Materials and methods: </strong>We conducted a retrospective population-based analysis using national registry data for all live births from January 2015 to December 2022. SRB was compared between pre-pandemic (2015-2019) and pandemic (2020-2022) periods. Interrupted time series analysis and baseline-derived 95% prediction intervals were employed to identify longitudinal shifts and month-specific anomalies.</p><p><strong>Results: </strong>Nationwide SRB significantly decreased from 105.48 (pre-pandemic) to 104.87 (pandemic) (p=0.032). In Daegu, SRB decreased to 98.2 in November 2020, nine months after the peak infection wave (February-March 2020), coinciding with a sharp reduction in total births. Additionally, SRB suppression was observed in early 2022, corresponding to conceptions during the prolonged phases of the pandemic.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic was associated with a significant SRB decline in South Korea. The nine-month lag observed in the Daegu epicenter aligns with a pre-fertilization mechanism, consistent with the exploratory hypothesis that acute societal stress may disproportionately impair Y-bearing sperm viability. These hypothesis-generating findings suggest SRB serves as a sensitive population-level indicator of societal distress.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"562-570"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicenter observational study on the efficacy and safety of 6-month Uro-Vaxom^® prophylaxis in women with recurrent urinary tract infection.","authors":"Jeong Woo Lee, Hae Do Jung, Joo Yong Lee, Hoon Choi, Tae Hyoung Kim","doi":"10.4111/icu.20260079","DOIUrl":"https://doi.org/10.4111/icu.20260079","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the clinical efficacy and safety of 6-month long-term prophylaxis with Uro-Vaxom^® in women with recurrent urinary tract infection (UTIs).</p><p><strong>Materials and methods: </strong>A total of 1,819 women aged ≥19 years with recurrent UTIs were enrolled from 70 institutions in Korea between November 2021 and May 2023. The primary endpoint was the number of UTI episodes during the 6-month Uro-Vaxom^® prophylaxis period compared with the 6 months before initiation of prophylaxis. Secondary endpoints included time until the appearance of the first UTI, duration of antibiotic use, patient satisfaction assessed by the Patient Global Impression of Change (PGIC), and adverse events (AEs).</p><p><strong>Results: </strong>The mean number of UTI episodes in the 1,066 evaluable patients significantly decreased during the Uro-Vaxom^® prophylaxis period compared with the preceding 6 months (0.32 vs. 2.14, p<0.0001). The mean time until the appearance of the first UTI was significantly prolonged during prophylaxis (68.89 days vs. 33.97 days, p<0.0001). The mean duration of antibiotic use decreased from 3.00 days before prophylaxis to 1.22 days during Uro-Vaxom^® use (p<0.0001). In the PGIC survey for changes in patient satisfaction, the proportion of patients who answered \"very much improved\" or \"much improved\" was 42.7% at 3 months of Uro-Vaxom^® use and 54.8% at 6 months. A total of 110 AEs were registered. Fourteen AEs in ten participants were assessed as serious but not unexpected or logically related to Uro-Vaxom^®.</p><p><strong>Conclusions: </strong>Six-month Uro-Vaxom^® prophylaxis demonstrated significant preventive efficacy and an acceptable safety profile in women with recurrent UTIs.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"571-578"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-triggered release of gemcitabine-loaded liposomes enhances intravesical therapy for bladder cancer.","authors":"Sejung Maeng, Mi Jeong Kim, Mirinae Kim, Jong Hyun Tae, Se Young Choi, Kyungchan Min, In Ho Chang, Hak Jong Lee, Joongwon Choi, Chung Un Lee, Yong Seong Lee, Jung Hoon Kim","doi":"10.4111/icu.20260076","DOIUrl":"https://doi.org/10.4111/icu.20260076","url":null,"abstract":"<p><strong>Purpose: </strong>Intravesical chemotherapy for bladder cancer is limited by insufficient urothelial drug penetration and rapid drug washout. We developed an ultrasound-responsive liposomal formulation that encapsulates gemcitabine to enable controlled intravesical drug release using a clinically available ultrasound system.</p><p><strong>Materials and methods: </strong>Gemcitabine-loaded liposomes (GEM-Lipo) were manufactured and characterized for their physicochemical properties and ultrasound-responsive drug release. Human bladder cancer cell lines (T24, 253J, and 5637) were evaluated in two-dimensional (2D) monolayer and three-dimensional (3D) spheroid cultures to assess cytotoxicity and intracellular drug uptake following ultrasound exposure (1.0-1.5 MHz). Therapeutic efficacy and safety were further investigated in an orthotopic MBT2-luciferase bladder cancer mouse model using intravesical GEM-Lipo combined with ultrasound treatment and longitudinal bioluminescence imaging.</p><p><strong>Results: </strong>Ultrasound exposure (1.5 MHz, 1 minute) significantly enhanced gemcitabine release from the liposomal carriers (p<0.01), resulting in increased intracellular drug accumulation and reduced cancer cell viability in both 2D and 3D cultures. Ultrasound-assisted delivery further augmented the cytotoxic effects of GEM-Lipo in spheroid cultures compared with liposomal treatment alone (p<0.01). The combination of GEM-Lipo and ultrasound produced the most pronounced suppression of orthotopic bladder tumor growth, as evidenced by the decreased bioluminescence signal (p<0.01), without detectable systemic toxicity.</p><p><strong>Conclusions: </strong>Clinically available ultrasound can activate GEM-Lipo, enhancing intravesical drug delivery and antitumor efficacy while maintaining safety. This platform offers a practical and translatable strategy for bladder-preserving therapy in non-muscle invasive bladder cancer.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"587-597"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Male gonadal function and cancer treatment: Current perspectives.","authors":"Koji Chiba, Hideaki Miyake","doi":"10.4111/icu.20260397","DOIUrl":"https://doi.org/10.4111/icu.20260397","url":null,"abstract":"<p><p>Recent advances in cancer treatment have markedly improved survival outcomes, increasing the importance of long-term quality of life issues, including male gonadal function. Cancer-related gonadal dysfunction results from the combined effects of the malignancy itself and anticancer therapies and primarily manifests as impaired spermatogenesis, although Leydig cell dysfunction may also contribute to long-term endocrine sequelae. Conventional treatments, including radiotherapy, surgery, and cytotoxic chemotherapy, have well-established gonadotoxic effects, whereas the long-term reproductive and endocrine consequences of newer anticancer therapies, such as molecular targeted agents and immune checkpoint inhibitors, remain incompletely understood. Although recovery of spermatogenesis is possible in some patients, persistent azoospermia and compensated or overt hypogonadism may develop after treatment. Sperm cryopreservation before gonadotoxic therapy remains the cornerstone of fertility preservation and should be considered for all eligible patients. In selected cancer survivors with persistent post-treatment azoospermia, microdissection testicular sperm extraction may provide an opportunity for biological fatherhood. In addition, increasing evidence suggests that long-term endocrine follow-up should address not only overt testosterone deficiency but also compensated Leydig cell dysfunction. As oncological outcomes continue to improve, clinicians should strive not only to cure cancer but also to preserve the long-term reproductive and endocrine health of cancer survivors through individualized treatment strategies and survivorship care.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"506-517"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>KIF23</i> is associated with a poor prognosis, basal subtypes and immunotherapy response in urothelial carcinoma.","authors":"Naofumi Nomura, Yohei Sekino, Yoshinori Shigematsu, Go Kobayashi, Hikaru Nakahara, Ryo Tasaka, Yuki Kohada, Kenshiro Takemoto, Miki Naito, Shunsuke Miyamoto, Kohei Kobatake, Hiroyuki Kitano, Keisuke Goto, Akihiro Goriki, Keisuke Hieda, Hiroaki Niitsu, Takao Hinoi, Nobuyuki Hinata","doi":"10.4111/icu.20260097","DOIUrl":"https://doi.org/10.4111/icu.20260097","url":null,"abstract":"<p><strong>Purpose: </strong>Kinesin family member 23 (KIF23), encoded by <i>KIF23</i>, is a microtubule-based motor protein essential for cytokinesis and mitotic progression. This study aimed to define the clinicopathological and biological significance of <i>KIF23</i> in urothelial carcinoma (UC), focusing on its expression patterns, molecular subtypes, prognosis, and treatment response, based on immunohistochemistry (IHC) and public database analyses.</p><p><strong>Materials and methods: </strong>KIF23 expression was evaluated by IHC in bladder cancer (BLCA) specimens. In addition, <i>in silico</i> analyses of publicly available datasets were performed to define its clinicopathological significance, its relationship with molecular subtypes, and its association with responses to chemotherapy and immunotherapy.</p><p><strong>Results: </strong>IHC revealed KIF23 positivity in 32.3% of BLCA cases. It was associated with squamous differentiation. <i>in silico</i> analysis revealed that <i>KIF23</i> expression levels in BLCA were higher than in normal urothelium and enriched in aggressive features, including higher T stage, muscle invasion, distant metastasis, and high grade. High <i>KIF23</i> expression was associated with basal molecular subtypes and a poor prognosis across multiple datasets. In contrast, high <i>KIF23</i> expression was correlated with a favorable prognosis after atezolizumab treatment. There was no significant association with the efficacy of chemotherapy. High <i>KIF23</i> expression was also associated with aggressive features, a poor prognosis, and basal subtype of upper tract UC.</p><p><strong>Conclusions: </strong>Our data suggest that <i>KIF23</i> is involved in the development and progression of UC and tends to be expressed in basal-type tumors. <i>KIF23</i> could be a potential therapeutic target and may serve as a biomarker for therapeutic stratification.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"530-542"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: Impact of COVID-19 on testicular torsion: A single-center retrospective study from a children's hospital.","authors":"Marko Bašković","doi":"10.4111/icu.20260102","DOIUrl":"https://doi.org/10.4111/icu.20260102","url":null,"abstract":"","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 6","pages":"612-614"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}