Investigative and Clinical Urology最新文献

{"title":"Engineered human adipose-derived stem cells delivering carboxylesterase and TRAIL for castration-resistant prostate cancer: Translational synthesis.","authors":"Jae Heon Kim, Sang Hun Lee, Yun Seob Song","doi":"10.4111/icu.20260217","DOIUrl":"10.4111/icu.20260217","url":null,"abstract":"<p><p>Castration-resistant prostate cancer (CRPC) remains poorly controlled after sequential androgen receptor-targeted agents, taxanes, and radiopharmaceuticals. Tumor-tropic adipose-derived mesenchymal stem cells (ADSCs) offer a compelling platform for local delivery of gene-based therapeutics. This review synthesizes the mechanistic rationale, preclinical evidence, and translational strategy for hTERT-immortalized ADSCs engineered to express carboxylesterase (CE), secreted TRAIL (sTRAIL), or both, administered with irinotecan (CPT-11) in CRPC. We compared five studies from our group with independent work using mesenchymal stem cells, neural stem cells, and other carriers delivering CE- or TRAIL-based payloads, situating this platform within the broader field. Our studies used ubiquitin C promoter lentiviral vectors to express rabbit CE, rabbit CE2, human sTRAIL, or CE+sTRAIL. Efficacy was assessed mainly in subcutaneous PC3 xenografts and a PC3 tibial bone-metastasis model in male nude mice, using standardized migration, cytotoxicity, and apoptosis assays with <i>in vivo</i> tumor volume and osteolysis endpoints. Across all five studies, engineered ADSCs showed preferential tumor-tropic migration and localization after systemic delivery and consistently enhanced irinotecan efficacy at low prodrug doses, while becoming SN-38-sensitive themselves, providing built-in self-elimination. CE2, with superior CPT-11 hydrolytic efficiency over CE1, added anti-tumor potency and was active against bone-metastatic CRPC, including suppression of osteolysis. This program establishes a biologically coherent, iteratively refined platform for tumor-selective enzyme-prodrug activation and death receptor-mediated apoptosis in CRPC. Translation requires resolving integrating-vector and hTERT immortalization safety concerns, quantitative biodistribution and persistence characterization, pharmacogenomics-informed irinotecan dosing, and immunogenicity assessment of xenogeneic CE.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"413-422"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873809","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":"Intravesical mitomycin-C administered immediately before transurethral resection of bladder tumor in non-muscle-invasive bladder cancer: Clinical outcomes and molecular predictors from over 3 years of extended follow-up in a phase II trial.","authors":"Hye Won Lee, Geehyun Song, Hyung Ho Lee, Eui Hyun Jung, Seo-Young Kim, Hanbyeol Kim, Weon Seo Park, Joonha Kwon, Ho Kyung Seo","doi":"10.4111/icu.20260135","DOIUrl":"10.4111/icu.20260135","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the long-term outcomes and molecular correlates of response after immediate preoperative intravesical chemotherapy (IPeIC) with mitomycin-C (MMC) in patients with non-muscle-invasive bladder cancer (NMIBC).</p><p><strong>Materials and methods: </strong>In this single-center, open-label, randomized phase II trial, 33 patients received two split doses of IPeIC/MMC (40 mg/20 mL), whereas 38 patients underwent transurethral resection of bladder tumor (TURBT) alone. The primary endpoint was 3-year recurrence-free survival (RFS), and secondary endpoints included progression-free survival (PFS). Exploratory RNA sequencing was performed on IPeIC-treated patients (three with recurrence, 25 without) using a Monte Carlo-based resampling strategy.</p><p><strong>Results: </strong>The median follow-up durations were comparable between the intervention (60.0 months) and control arms (60.4 months). IPeIC/MMC reduced recurrence risk by 76.8% versus TURBT alone (p=0.024), yielding a 3-year RFS rate of 90.7% versus 78.6%. On multivariable analysis, IPeIC/MMC independently improved RFS (hazard ratio [HR] 0.266, p=0.044). IPeIC was associated with superior PFS, with 3-year and 5-year rates of 100% versus 92.1% and 85.8%, respectively, in the controls (HR 0.078, p=0.014). Exploratory transcriptomics identified low Glutathione S-transferase Mu 1 (GSTM1) expression as the factor most strongly associated with recurrence.</p><p><strong>Conclusions: </strong>IPeIC/MMC is associated with improved long-term oncological outcomes compared with TURBT alone and represents a safe prophylactic option for patients with NMIBC who are unable to receive standard immediate postoperative intravesical chemotherapy because of safety concerns or practical constraints. The GSTM1 findings are hypothesis-generating and support future biomarker-driven validation studies.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"441-451"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873972","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 discordance in outside prostate biopsies: Implications for active surveillance patient selection.","authors":"Hyean Jun Park, Jong Ho Park, Younsoo Chung, Hyung Joon Kim, Hakmin Lee, Jong Jin Oh, Sangchul Lee, Seong Jin Jeong, Sung Kyu Hong, Seok-Soo Byun, Sang Hun Song","doi":"10.4111/icu.20260093","DOIUrl":"10.4111/icu.20260093","url":null,"abstract":"<p><strong>Purpose: </strong>Gleason grade group (GG) concordance between prostate biopsy and radical prostatectomy (RP) is critical for treatment planning, particularly for active surveillance (AS). We compared GG concordance, upgrade rates, and AS misclassification between institutional and outside biopsies and evaluated the impact of pathologic re-evaluation.</p><p><strong>Materials and methods: </strong>In this propensity score-matched cohort study, 3,744 patients (1,872 institutional and 1,872 outside biopsies) who underwent RP were analyzed. Outside biopsies were stratified by re-evaluation status (re-evaluated, n=570; not re-evaluated, n=1,302). Primary outcomes included overall GG concordance, clinically significant upgrade (≥2 GG), and AS misclassification (biopsy GG 1 to RP ≥GG 3). Agreement was assessed using weighted kappa statistics, and predictors of upgrade were identified by multivariable logistic regression.</p><p><strong>Results: </strong>Overall GG concordance was 44.7%. Institutional biopsies showed the highest concordance (47.8%) compared to outside biopsies with (45.3%) and without re-evaluation (40.0%) (p<0.001). Among biopsy GG 1 patients, AS misclassification to ≥GG 3 occurred in 9.6% of institutional biopsies, compared to 27.0% of outside re-evaluated biopsies and 20.0% of outside non-re-evaluated biopsies (p<0.0001). Outside biopsy source (odds ratio [OR] 1.351, p=0.013) and absence of re-evaluation (OR 1.451, p=0.028) were identified as independent predictors of GG upgrade.</p><p><strong>Conclusions: </strong>Outside prostate biopsies exhibit 2.1- to 2.8-fold higher AS misclassification rates compared to institutional biopsies. Pathologic re-evaluation provides only modest improvement and does not eliminate upgrade risk, supporting systematic second-opinion review and careful confirmation before AS enrollment.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"452-458"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872936","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":"Effect of intrinsic sphincter deficiency on treatment success following urethral bulking with polyacrylamide hydrogel.","authors":"Bertie Geng, Layla Joudeh, Ayanna Garland, Elizabeth J Geller","doi":"10.4111/icu.20260022","DOIUrl":"10.4111/icu.20260022","url":null,"abstract":"<p><strong>Purpose: </strong>Intrinsic sphincter deficiency (ISD) is associated with lower stress urinary incontinence (SUI) treatment success. Polyacrylamide hydrogel (PH) is a widely used urethral bulking material in treating SUI. Our goal is to compare treatment outcomes in women with and without ISD who underwent urethral bulking with PH for SUI.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort analysis of women who underwent urethral bulking with PH from October 2022 to November 2024. Exclusions included no SUI on preoperative urodynamics, prior surgical SUI treatment, or no follow-up visit. ISD was defined as cough or Valsalva leak point pressure ≤60 cm H₂O or maximal urethral closure pressure ≤20 cm H₂O on preoperative urodynamics. Treatment success was defined as no SUI or improved SUI at initial follow-up.</p><p><strong>Results: </strong>Of the 171 participants included, 21 (12.3%) met criteria for ISD. Those with ISD were older and received a greater amount of PH compared to those without ISD (1.79 mL vs. 1.65 mL, p=0.05). There were no differences in self-reported race/ethnicity, body mass index, parity, or rates of concomitant prolapse repair. There were no differences in uroflow or micturition pattern or bladder sensation on preoperative urodynamics. Treatment success was high in both (95.2% with ISD vs. 89.9% without ISD, p=0.70). Rates of SUI retreatment were low in both and did not differ.</p><p><strong>Conclusions: </strong>While there were some differences between those with and without ISD, both had high treatment success rates. Using PH bulking injection to treat SUI in those with ISD is reasonable.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"488-495"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873099","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":"Predictors of active surveillance discontinuation in prostate cancer: Large Korean multicenter cohort study.","authors":"Joongwon Choi, Chung Un Lee, Seong Soo Jeon, Seok Soo Byun, Jae Young Joung, Hanjong Ahn, Jin Seon Cho, Sung Woo Park, Dong Deuk Kwon, U-Syn Ha, Jae Young Park, Tae Gyun Kwon, Jung Ki Jo, Chang Wook Jeong, Cheol Kwak","doi":"10.4111/icu.20260118","DOIUrl":"10.4111/icu.20260118","url":null,"abstract":"<p><strong>Purpose: </strong>Active surveillance (AS) is an established management strategy for favorable-risk prostate cancer (PCa). In real-world practice, decisions to continue AS or active treatment (AT) are influenced by both disease-related and patient-related factors. This study aimed to identify factors associated with the transition from AS to AT in a large multicenter cohort.</p><p><strong>Materials and methods: </strong>We analyzed 716 patients with PCa managed with AS across 12 institutions. Baseline clinical characteristics, comorbidity burden assessed via the Charlson comorbidity index (CCI), performance status evaluated using the Eastern Cooperative Oncology Group (ECOG) score, and disease-related factors, including prostate-specific antigen (PSA), PSA density (PSAD), and magnetic resonance imaging findings, were collected. Cox proportional hazards regression was used to identify factors associated with conversion to AT.</p><p><strong>Results: </strong>During a mean follow-up of 28.4 months, 224 patients (31.3%) transitioned from AS to AT, most frequently because of pathologic reclassification (60.3%). In multivariate analysis, maximum core involvement (hazard ratio [HR] 1.015, p=0.003) and PSAD ≥0.10 ng/mL/cm³ (HR 1.478, p=0.044) were independently associated with conversion to AT. Although ECOG performance status and CCI were not statistically significant in multivariate models, patients with poorer functional status or greater comorbidity burden remained on AS rather than proceeding to AT.</p><p><strong>Conclusions: </strong>In this large multicenter study, PSAD was the strongest predictor of transition to AT during AS for PCa. Beyond disease-related factors, patient condition also appeared to influence real-world decisions about continuing AS.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"459-467"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874072","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":"Can we predict which cryptorchidism will descend? A cohort study in 976 Korean neonates.","authors":"Yeonwoo Jeong, Do Gyeong Lim, Seong Hyeon Yu, Ho Seok Chung, Sun-Ouck Kim","doi":"10.4111/icu.20250660","DOIUrl":"10.4111/icu.20250660","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the incidence and perinatal risk factors associated with undescended testis (UDT) in neonates and to identify predictors of persistent UDT at 6 months of age.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included 976 male neonates born at Chonnam National University Hospital between 2018 and 2023. Clinical variables included birth weight, gestational age, Apgar score, delivery mode, urogenital anomalies, maternal age, estrogen exposure, and family history. UDT was diagnosed at birth, and spontaneous descent was assessed at 6 months. Logistic regression identified significant predictors.</p><p><strong>Results: </strong>UDT incidence was 8.8% (86/976), significantly higher in preterm than term infants (28.1% vs. 3.1%, p<0.001). Low birth weight (odds ratio [OR] 3.82, p<0.001), prematurity (OR 2.75, p=0.001), maternal estrogen exposure (OR 2.57, p=0.006), and urogenital anomalies (OR 2.13, p=0.026) were independent predictors of UDT at birth. Among infants with UDT, 72.1% showed spontaneous descent by 6 months. Urogenital anomalies were associated with a lower likelihood of spontaneous descent (OR 0.32, p=0.028), whereas prematurity, low birth weight, and maternal estrogen exposure increased the likelihood of descent.</p><p><strong>Conclusions: </strong>UDT is relatively common in Korean neonates, particularly among preterm infants. While most cases resolve spontaneously within 6 months, infants with urogenital anomalies are less likely to descend spontaneously and may need closer follow-up and earlier surgical consideration. Early perinatal characteristics may help stratify the risk of persistent UDT and guide clinical decision-making.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"496-501"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872888","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":"Work and life satisfaction of female urologists in Korea.","authors":"Jung Hyun Shin, Hye Jin Byun, Young Ju Lee, Ju Hyun Shin, Mi Mi Oh","doi":"10.4111/icu.20260062","DOIUrl":"10.4111/icu.20260062","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate career satisfaction, mentorship experience, work-life balance, and perceptions of gender discrimination among female urology residents and specialists in Korea.</p><p><strong>Materials and methods: </strong>A nationwide cross-sectional survey was conducted among female urologists, including residents and board-certified specialists. The questionnaire assessed demographic characteristics, mentorship experience, career satisfaction, personal life satisfaction, work-related stress, and experiences of gender discrimination.</p><p><strong>Results: </strong>A total of 41 respondents participated, including 11 residents and 30 specialists. Most specialists (63.3%) practiced in tertiary or secondary hospitals, and 21 (70.0%) specialized in female urology or voiding dysfunction. Only 9.1% of residents and 33.3% of specialists reported substantial mentorship during training, with the most common barrier being the absence of experts in the desired field. While 60.0% of specialists and 54.5% of residents stated they would choose urology again, 56.7% and 45.5%, respectively, would not recommend the specialty to their children. Residents reported higher work-related stress (median, 7 vs. 5, p>0.05), whereas personal life satisfaction was similar between groups (median, 6 vs. 7, p>0.05). All residents reported workload adjustments, whereas 95.0% of specialists reported unchanged duties. Approximately one-third experienced gender discrimination, mainly during residency, most often from colleagues or patients, and 81.6% perceived male preference in employment.</p><p><strong>Conclusions: </strong>Female urologists in Korea demonstrate strong professional dedication but there remain challenges related to mentorship scarcity, gender bias, and work-life imbalance. Efforts to strengthen mentorship and promote equitable workplace policies are essential to enhance satisfaction and retention among women in urology.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"423-430"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874075","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":"Residential location shapes initial prostate cancer care in Korea (2010-2020): A nationwide stage- and risk-stratified study.","authors":"Young Hwii Ko, Sang Won Kim, Nak-Hoon Son","doi":"10.4111/icu.20260160","DOIUrl":"10.4111/icu.20260160","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize nationwide patterns of initial prostate cancer (PCa) management in Korea from 2010 to 2020, stratified by clinical stage, risk, and residential context.</p><p><strong>Materials and methods: </strong>We performed a secondary analysis of a chart-abstracted cohort from 51 general hospitals. Initial treatment was classified into ten mutually exclusive categories (active surveillance; surgery; surgery after androgen deprivation therapy [ADT]; radiotherapy; radiotherapy after ADT; docetaxel after ADT; androgen receptor-targeted agent [ARTA] after ADT; ADT-only ≥1 year; other active treatment; unknown). Localized disease (T1-T4N0M0) was stratified by risk (low, intermediate, and high). Residential context was coded as capital versus non-capital and urban versus rural. National Comprehensive Cancer Network risk stratification (version 2.2024) was applied uniformly across survey years.</p><p><strong>Results: </strong>Among 27,075 men, initial management differed significantly by stage, risk, and residence. In localized disease, surgery predominated, active surveillance was most frequent in low-risk disease, and radiotherapy and ADT-only increased with higher risk (p<0.001). Over time, ADT-only decreased in metastatic disease, with increases in radiotherapy and systemic intensification (p=0.004). Capital and urban residence were associated with greater use of surgery in localized disease and systemic intensification in metastatic disease, whereas non-capital and rural residence relied more on ADT-only (all p<0.001). In multivariable analyses, residential context remained independently associated with treatment selection after adjustment for age, prostate-specific antigen, grade, and stage.</p><p><strong>Conclusions: </strong>Initial PCa management in Korea during the 2010s reflected contemporary adoption of surgical and systemic therapies but demonstrated persistent geographic variation, indicating residential context influences real-world access to guideline-concordant care.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"468-477"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874102","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":"Impact of changes in metabolic health and obesity on incident urolithiasis: A nationwide cohort study.","authors":"Won Ku Hwang, Tae Hyun Lee, Hyo Jong Kim, Seon Beom Jo, Jong Wook Kim, Mi Mi Oh, Hong Seok Park, Du Geon Moon, Sun Tae Ahn","doi":"10.4111/icu.20250724","DOIUrl":"10.4111/icu.20250724","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether time-varying changes in metabolic health and obesity status are associated with incident urolithiasis using a nationwide health-screening cohort.</p><p><strong>Materials and methods: </strong>The National Health Insurance Service-National Health Screening database was used for this study. The study cohort consisted of 514,866 health screening examinees between 2009 and 2010. Metabolic health was determined based on triglyceride, high-density lipoprotein cholesterol, fasting glucose, blood pressure, and waist circumference criteria, while obesity was determined by body mass index. The participants were stratified into metabolically healthy non-obese (MHNO); metabolically unhealthy non-obese (MUNO); metabolically healthy obese (MHO); metabolically unhealthy obese (MUO). According to the second health screening, each group was divided according to changes in metabolic status and obesity. Cox proportional hazards regression was used to determine adjusted hazard ratios (aHRs) and 95% confidence intervals.</p><p><strong>Results: </strong>A total of 286,175 examinees who contributed 1,958,405 person-years of follow-up were eligible for this cohort study, during which 12,403 subjects developed urolithiasis. Compared with MHNO individuals, aHRs for incident urolithiasis were higher in MUO, MHO, and MUNO groups. Persistent obesity or metabolic unhealthiness was associated with higher aHRs, whereas improvement in either status was associated with lower aHRs.</p><p><strong>Conclusions: </strong>We found that aHRs for incident urolithiasis were similarly elevated in metabolically healthy and unhealthy obese individuals compared with MHNO individuals, indicating that excess adiposity may be a key driver of stone risk. Maintaining metabolic health and normal weight or improving metabolic health and reducing weight may lead to decreased risk of urolithiasis development.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"478-487"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873805","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":"Non-antibiotic treatments for the management of recurrent urinary tract infection in the multidrug resistance era: A narrative review.","authors":"Dong Soo Kim, Chang Il Choi, Jin Bong Choi, Taesoo Choi, Jeong Woo Lee","doi":"10.4111/icu.20250655","DOIUrl":"10.4111/icu.20250655","url":null,"abstract":"<p><p>Recurrent urinary tract infections (UTIs) are a significant global health burden, increasingly complicated by antibiotic resistance. Traditional approaches with antibiotics increase the risk of multidrug-resistant (MDR) strains, emphasizing the need for new non-antibiotic treatments. Several promising approaches have emerged during the last decade. Microbiome-based therapies, including probiotics, asymptomatic bacteriuria strains, and fecal microbiota transplantation, aim to restore microbial balance. Immunomodulation, through cytokine targeting and bacterial vaccines, shows potential for boosting host defenses. Bacteriophage therapy offers precision targeting of MDR pathogens and biofilms. Nanoparticles enable targeted delivery and biofilm disruption through both organic and inorganic carriers. Additionally, agents like methenamine hippurate, D-mannose, estrogen, and cranberry extracts have shown varying degrees of efficacy and safety. These strategies represent essential steps toward sustainable UTI management, but most will require further clinical validation before their use in the general population.</p>","PeriodicalId":14522,"journal":{"name":"Investigative and Clinical Urology","volume":"67 5","pages":"403-412"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873965","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}