Investigative and Clinical Urology最新文献

{"title":"COVID-19 infection may reduce serum testosterone levels and increase the risk of erectile dysfunction: A two-sample Mendelian randomization study.","authors":"Ting Wang, Chao Li, Jinbo Song","doi":"10.4111/icu.20240384","DOIUrl":"10.4111/icu.20240384","url":null,"abstract":"<p><strong>Purpose: </strong>Coronavirus disease 2019 (COVID-19) infection may affect serum hormones levels and male sexual function. This study aims to provide evidence for the causal relationship between COVID-19 infection, serum testosterone levels and the risk of erectile dysfunction (ED) using a two-sample Mendelian randomization (MR) approach.</p><p><strong>Materials and methods: </strong>Summary-level data for serum testosterone levels (199,569 samples and 12,321,875 single nucleotide polymorphisms [SNPs]) were obtained from Rebecca's study, while data for ED (6,175 cases and 217,630 controls) were sourced from Bovijn's study. Genetic variations linked to COVID-19 were used as instrumental variables (IVs) in meta-analyses of genome-wide association studies (GWASs) involving 6,406 cases and 902,088 controls from the COVID-19 Host Genetics Initiative. The inverse-variance weighted (IVW) method was primarily employed to evaluate the potential associations between COVID-19 infection, serum testosterone levels, and the risk of ED. The weighted mode, weighted-median and simple-median method were employed to evaluate the sensitivity. Heterogeneity and pleiotropic outlier were assessed using Cochran's Q test and MR-Egger regression.</p><p><strong>Results: </strong>The MR analysis demonstrated that COVID-19 infection was associated with reduced serum testosterone levels (odds ratio [OR] 0.966, 95% confidence interval [CI] 0.938-0.993, p=0.016) and an increased risk of ED (OR 1.205, 95% CI 1.063-1.367, p=0.004) when using IVW methods. Sensitivity analyses utilizing various IV sets and MR approach remained consistent.</p><p><strong>Conclusions: </strong>COVID-19 infection is associated with a decrease in serum testosterone levels and an increased risk of ED. Male patients recovering from COVID-19 need to pay special attention to their sex hormone levels and sexual health.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"152-160"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567071","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":"Combination of intrarectal heated lidocaine gel and periprostatic nerve block for pain control during transrectal ultrasound-guided prostate biopsy: A prospective randomized trial.","authors":"Jung Im Kim, Dong Wan Sohn, Bong Hee Park","doi":"10.4111/icu.20240312","DOIUrl":"10.4111/icu.20240312","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the role of combined periprostatic nerve block (PNB) and intrarectal local anesthesia with heated lidocaine gel (ILAHL) in reducing pain during transrectal ultrasound (TRUS)-guided prostate biopsy, compared with PNB alone.</p><p><strong>Materials and methods: </strong>We performed a prospective randomized trial with 140 participants who underwent systematic TRUS-guided, 12-core prostate biopsy from July 2021 to June 2022. These participants were divided into two groups. Before prostate biopsy, group 1 (n=70) received PNB and group 2 (n=70) received PNB combined intrarectal local anesthesia with 20 mL of heated (40℃) 2% lidocaine gel. The primary outcome was pain score on a 0-10 visual analogue scale (VAS) at four time points (VAS A: during local anesthesia procedure, VAS B: during probe insertion, VAS C: during biopsy procedure, VAS D: 30 minutes after biopsy). The secondary outcome included adverse events during and after the procedure.</p><p><strong>Results: </strong>Mean pain scores were significantly lower in group 2 than in group 1 at VAS A (2.53 vs. 1.60, p=0.001) and VAS B (2.47 vs. 1.49, p<0.001). The mean VAS C pain score in group 2 was significantly less than in group 1 (3.07 vs. 2.20, p=0.001), while there was no significant difference in the mean VAS D pain score between two groups (1.06 vs. 0.89, p=0.318). There were no significant differences in the occurrence of complications in both groups.</p><p><strong>Conclusions: </strong>The combination of PNB and ILAHL provides more effective pain control than PNB alone without increase of complication rates in patients undergoing TRUS-guided prostate biopsy.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"130-136"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567050","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":"Comparison of encrustation between silicon-covered and polytetrafluoroethylene-covered metallic stent, <i>in vitro</i> experimental study.","authors":"Deok Hyun Han, Woo Jin Bang, Jae Hoon Chung","doi":"10.4111/icu.20240410","DOIUrl":"10.4111/icu.20240410","url":null,"abstract":"<p><strong>Purpose: </strong>To compare encrustation resistance between silicon- and polytetrafluoroethylene (PTFE)-covered metallic ureteral stents (MUS) in an <i>in vitro</i> infection model and to determine the most effective material for reducing biofilm formation and encrustation.</p><p><strong>Materials and methods: </strong>A total of 52 MUS were prepared: 26 silicon-covered and 26 PTFE-covered stents. Each sample was immersed in artificial urine inoculated with <i>Proteus mirabilis</i> in a biofilm reactor for 48 hours. After immersion, the stents were weighed to measure their encrustation level. Scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) were used to assess the surface morphology and elemental composition of the encrustation deposits.</p><p><strong>Results: </strong>Silicon-covered stents showed a statistically significant reduction in weight gain due to encrustation compared to PTFE-covered stents (9.50±5.77 mg vs. 16.75±10.61 mg; p=0.004). Additionally, encrustation per unit length was lower in silicon-covered stents (0.76±0.45 mg/mm vs. 1.30±0.81 mg/mm; p=0.004). SEM and EDS analyses demonstrated lower calcium salt deposition on the silicon-covered stents, indicating greater resistance to encrustation.</p><p><strong>Conclusions: </strong>Silicon-covered MUS demonstrated superior resistance to encrustation compared to PTFE-covered stents, supporting silicon as a more suitable covering material for long-term MUS applications. This finding may lead to extended stent lifespans and a reduced frequency of stent replacements, benefiting both patients and healthcare systems.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"137-143"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567057","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":"Nationwide surveillance of antimicrobial resistance for uncomplicated cystitis in 2023: Conducted by the Korean Association of Urogenital Tract Infection and Inflammation.","authors":"Seong Hyeon Yu, Seung Il Jung, Seung-Ju Lee, Mi-Mi Oh, Jin Bong Choi, Chang Il Choi, Yeon Joo Kim, Dong Jin Park, Sangrak Bae, Seung Ki Min","doi":"10.4111/icu.20240302","DOIUrl":"10.4111/icu.20240302","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to report the results of Korean Antimicrobial Resistance Monitoring System (KARMS) for uncomplicated cystitis (UC) in 2023.</p><p><strong>Materials and methods: </strong>KARMS was established for the surveillance of antimicrobial resistance in urinary tract infections with the cooperation of Korean nationwide medical centers. Data from patients with UC have been collected in the web-based KARMS database. Demographic data, uropathogen distribution, and antimicrobial susceptibility of representative pathogens were analyzed.</p><p><strong>Results: </strong>A total of 885 patients' data were collected in KARMS database. The mean patient age was 56.39±18.26 years. The number of postmenopausal and recurrent cystitis were 530 (61.1%) and 102 (11.5%), respectively. <i>Escherichia coli</i> was the most frequently identified uropathogen (654/871, 75.1%). Regarding antimicrobial susceptibility, 94.9% were susceptible to fosfomycin, 90.5% to nitrofurantoin, 58.4% to ciprofloxacin, 83.6% to cefotaxime, and 100.0% to ertapenem. ESBL positivity was 13.7% (96/702), and significantly higher in tertiary hospital (23.1%, p<0.001), postmenopausal (15.9%, p=0.044), and recurrent cystitis (24.7%, p=0.001). Fluoroquinolone resistance was significantly higher in tertiary hospital (47.4%, p=0.001), postmenopausal (44.9%, p<0.001), and recurrent cystitis (59.8%, p<0.001). In addition, postmenopausal (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.38-2.77, p<0.001) and recurrent cystitis (OR 2.37, 95% CI 1.44-3.92, p=0.001) were associated with increased fluoroquinolone resistance.</p><p><strong>Conclusions: </strong>These data provide information on the distribution of uropathogen and the status of antimicrobial resistance in UC of South Korea. In addition, KARMS will be a useful reference in the future through the continuous surveillance system construction over the years.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"161-171"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567112","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":"Carbon footprints in the urologic field: From diagnosis to surgery.","authors":"Jongsoo Lee, Miho Song, Jae Heon Kim","doi":"10.4111/icu.20250004","DOIUrl":"10.4111/icu.20250004","url":null,"abstract":"<p><p>Climate change and its effects on society represent an increasingly critical concern. The healthcare industry contributes substantially to carbon emissions and bears responsibility for managing its environmental impact. This review examines recent progress, challenges, and future prospects in reducing the carbon footprint of diagnostic urology without compromising patient care, with particular emphasis on imaging. We analyze the environmental effects of urological procedures and devices, along with practices that can minimize greenhouse gas emissions. Promoting sustainability in healthcare requires a comprehensive approach from manufacturing to disposal, including examination of sterilization-related carbon footprints. This work aims to analyze existing literature on urological carbon footprints, focusing on processes and practices within the field.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"106-113"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567043","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":"Efficacy of scheduled intravenous acetaminophen administration for catheter-related bladder discomfort in patients after transurethral resection of bladder tumors: A prospective randomized pilot study.","authors":"Tomoya Hatayama, Koji Mita, Yuki Kohada, Kenta Fujiyama, Ryo Tasaka, Akihiro Goriki, Hideki Mochizuki, Nobuyuki Hinata","doi":"10.4111/icu.20240357","DOIUrl":"10.4111/icu.20240357","url":null,"abstract":"<p><strong>Purpose: </strong>Scheduled administration of intravenous acetaminophen improves catheter-related bladder discomfort (CRBD) after urological surgery. However its efficacy for patients undergoing transurethral resection of bladder tumors (TURBT) remains unclear. This study aimed to investigate the efficacy of scheduled administration of intravenous acetaminophen after TURBT.</p><p><strong>Materials and methods: </strong>At the end of surgery, patients in both the control (n=39) and the scheduled administration (n=45) groups received analgesics at the discretion of the anesthesiologists. In the scheduled administration group, intravenous acetaminophen was administered every 4 hours for 12 hours after the surgery. Both groups were administered on-demand analgesics as needed. The primary outcome was CRBD scores, and the secondary outcomes were the face rating scale for lower abdominal pain, administration rates of additional analgesics, durations of bladder catheterization, lengths of postoperative hospital stay, and postoperative complication rate.</p><p><strong>Results: </strong>The scheduled administration group had significantly lower CRBD scores than those of the control group at 8 hours postoperatively (p=0.014), and lower administration rates of additional analgesics 4-8 hours (p=0.029) and 8-12 hours (p=0.027) postoperatively compared to those of the control group. Other secondary outcomes were not significantly different between the groups (all p>0.05). The scheduled administration group did not have postoperative complications related to the scheduled administration of intravenous acetaminophen.</p><p><strong>Conclusions: </strong>Scheduled intravenous acetaminophen administration alleviated postoperative CRBD and reduced the need for additional analgesics in patients who underwent TURBT. These findings can be utilized to improve the quality of postoperative care.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"144-151"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567074","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":"Diagnostic value of prostate health index in patients with no index lesion on mpMRI or negative previous combined biopsy.","authors":"Seong Soo Jeon, Wan Song, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Byeong Chang Jeong, Seong Il Seo, Jae Hoon Chung","doi":"10.4111/icu.20250007","DOIUrl":"10.4111/icu.20250007","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the effectiveness of the prostate health index (PHI) in patients with no index lesions on multiparametric magnetic resonance imaging (mpMRI) or with negative findings on past prostate biopsy if there was an index lesion on mpMRI.</p><p><strong>Materials and methods: </strong>Patients without an index lesion on MRI or with a negative result on combined biopsy for index lesions were assessed. Patients who underwent transperineal mapping biopsy among those suspected of having prostate cancer (PCa) due to persistently elevated prostate-specific antigen (PSA) levels were analyzed.</p><p><strong>Results: </strong>Of the 291 patients, 82 (28.2%) were diagnosed with PCa. Sixty-five of 291 patients had negative finding in previous combined biopsy. In total, 226 patients did not have any index lesions. The mean age of the PCa group was 64.33±8.88 years and that of the non-cancer group was 59.88±10.26 years (p<0.001). The PHI was 46.75±28.22 in the PCa group and 37.74±17.37 in the non-cancer group (p=0.001), and the prostate volume was 41.52±15.77 mL in the PCa group and 50.78±23.97 mL in the non-cancer group (p=0.001). In multivariate analysis, age (odds ratio [OR] 1.096, p<0.001), PHI (OR 1.021, p=0.005), and prostate volume (OR 0.954, p<0.001) were identified as significant factors for PCa detection. The optimal cutoff value of the PHI for PCa detection was 44.6 and the PHI density (PHID) was 0.88.</p><p><strong>Conclusions: </strong>In patients with elevated PSA levels but no index lesions on mpMRI or negative biopsy findings, PHI and PHID demonstrated significant potential for improving PCa detection.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"124-129"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567073","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":"Changes in urologic research from a new perspective: Text mining analysis of publication topics.","authors":"Soohyung Joo, Kun Lu, Jihwan Park, Mi Jung Rho, Yong Hyun Park","doi":"10.4111/icu.20240388","DOIUrl":"10.4111/icu.20240388","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to explore the trends in research keywords and topics in the field of urology based on text mining over the recent decades. The investigation looked into changes in frequent subject keywords and the trends in prevailing research topics, as reflected in representative urology journals over recent decades.</p><p><strong>Materials and methods: </strong>A total of 27,129 bibliographic documents were collected from four urology journals, including <i>European Urology</i>, <i>Journal of Urology</i>, <i>BJU International</i>, and <i>World Journal of Urology</i>. The study then examined the changes in the most frequent author keywords over the decades. Moreover, structured topic modeling was employed to identify twenty prevailing research topics in urology and to examine their trends across different periods.</p><p><strong>Results: </strong>The study observed consistently increasing patterns in author keywords and topics related to the prostate and oncology. Conversely, research fields such as pediatrics, male infertility, voiding dysfunction, and cancer biology exhibited a downward trend in urology. Potential factors or reasons underlying these trends were further discussed in this study.</p><p><strong>Conclusions: </strong>This exploratory study uncovered major research topics in the discipline of urology. The findings of this study depict the domain of urology research in recent decades, providing insights for both researchers and clinicians seeking to better understand the research trends in the discipline.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"172-180"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567047","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":"Comparative efficacy and safety of energy coagulation in radiation-induced hemorrhagic cystitis: A narrative review.","authors":"Wei Chern Khern, Retnagowri Rajandram, Novinth Kumar Raja Ram, Shanggar Kuppusamy","doi":"10.4111/icu.20240288","DOIUrl":"10.4111/icu.20240288","url":null,"abstract":"<p><p>To assess the efficacy and safety of using energy devices as treatment for radiation-induced hemorrhagic cystitis (RHC) and to determine the most suitable energy source, settings and techniques based on laser-tissue interaction. A search of Google Scholar, PubMed, and Web of Science databases was conducted uptil February 2024 to identify studies on use of energy devices for RHC. Additionally, ClinicalTrials.gov and the World Health Organization's ICTRP (International Clinical Trials Registry Platform) were searched for ongoing studies. We identified 10 studies fulfilling the search criteria using modalities including Nd:YAG laser, argon plasma coagulation, 980-nm diode laser, and potassium-titanyl-phosphate (KTP) laser. Across studies (n=137), majority (n=116, 84.7%) of RHC patients achieved hematuria resolution after one treatment session, with mean/median hematuria-free intervals of 11 to 16 months. Six patients (4.4%) were unresponsive and underwent cystectomy/urinary diversion. Total adverse events occurred in patients (30/139, 21.6%), including storage symptoms, recurrent hematuria, bladder stones and urinary retention, among others. Typical laser settings involved low power (<40 W), with either a pulse duration of 2-3 seconds or 10-40 milliseconds; some used continuous wave mode. Other standard practises include selective coagulation employed in a \"painting\" fashion and non-contact mode (3-5 mm). The treatment endpoints were hemostasis, involution of telangiectatic vessels and formation of pale well-circumscribed mucosal ulcer. Energy devices have considerable efficacy and safety to treat RHC patients and can be considered for refractory RHC and as an adjunct after initial management. The various properties of KTP laser confers an advantage over other energy devices.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"97-105"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567053","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":"Risk-adapted scoring model to identify candidates benefiting from adjuvant chemotherapy after radical nephroureterectomy for localized upper urinary tract urothelial carcinoma: A multicenter study.","authors":"Sung Jun Sou, Ja Yoon Ku, Kyung Hwan Kim, Won Ik Seo, Hong Koo Ha, Hui Mo Gu, Eu Chang Hwang, Young Joo Park, Chan Ho Lee","doi":"10.4111/icu.20240323","DOIUrl":"10.4111/icu.20240323","url":null,"abstract":"<p><strong>Purpose: </strong>Adjuvant chemotherapy (AC) is recommended for muscle-invasive or lymph node-positive upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). However, disease recurrences are frequently observed in pT1 disease, and AC may increase the risk of overtreatment in pT2 UTUC patients. This study aimed to validate a risk-adapted scoring model for selecting UTUC patients with ≤pT2 disease who would benefit from AC.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 443 ≤pT2 UTUC patients who underwent RNU. A risk-adapted scoring model was applied, categorizing patients into low- or high-risk groups. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed according to risk group.</p><p><strong>Results: </strong>Overall, 355 patients (80.1%) and 88 patients (19.9%) were categorized into the low- and high-risk groups, respectively, with the latter having higher pathological stages, concurrent carcinoma <i>in situ</i>, and synchronous bladder tumors. Disease recurrence occurred in 45 patients (10.2%), among whom 19 (5.4%) and 26 (29.5%) belonged to the low- and high-risk groups, respectively (p<0.001). High-risk patients had significantly shorter RFS (64.3% vs. 93.6% at 60 months; hazard ratio [HR] 13.66; p<0.001) and worse CSS (80.7% vs. 91.5% at 60 months; HR 4.25; p=0.002). Multivariate analysis confirmed that pT2 stage and the high-risk group were independent predictors of recurrence and cancer-specific death (p<0.001). Decision curve analysis for RFS showed larger net benefits with our model than with the T stage model.</p><p><strong>Conclusions: </strong>The risk-adapted scoring model effectively predicts recurrence and identifies optimal candidates for AC post RNU in non-metastatic UTUC.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"66 2","pages":"114-123"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567113","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}