Therapeutic Advances in Urology最新文献

{"title":"Therapeutic advances in ureteral stricture: lessons from radiation-induced fibrosis to regenerative strategies-a narrative review.","authors":"Xuan Zhou, Pu Chen, Jiatai He, Zhihao Wei, Xin Zheng, Daojia Miao, Zhiyong Xiong, Xiaoping Zhang","doi":"10.1177/17562872261442681","DOIUrl":"https://doi.org/10.1177/17562872261442681","url":null,"abstract":"<p><p>Radiation-induced ureteral stricture (RIUS) is a rare but refractory late complication of pelvic radiotherapy, driven by severe fibrosis and microvascular injury that undermines the effectiveness of conventional interventions such as balloon dilation, ureteral stenting, and reconstructive surgery. This review summarizes the pathophysiological basis of treatment resistance in RIUS and critically appraises current management strategies. Beyond its clinical relevance, RIUS is discussed as a paradigmatic model of advanced fibrotic ureteral disease, offering broader insights into the limitations of purely mechanical approaches. We further examine emerging biologically oriented strategies, including mesenchymal stem cell-derived extracellular vesicle-based regenerative therapies, next-generation ureteral stents incorporating advanced biomaterials, and drug-eluting stent platforms for localized antifibrotic and antimicrobial delivery. Although largely investigational, these approaches collectively signal a conceptual shift from palliative drainage toward biologically informed, restorative management of RIUS and related refractory ureteral strictures.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261442681"},"PeriodicalIF":3.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported quality-of-life outcomes after ATOMS surgery for post-prostatectomy stress urinary incontinence managed with an on-demand follow-up strategy.","authors":"Ingunn Roth, Karin Margrethe Hjelle, Christian Beisland, Christian Arvei Moen, Patrick Juliebø-Jones","doi":"10.1177/17562872261442654","DOIUrl":"https://doi.org/10.1177/17562872261442654","url":null,"abstract":"<p><strong>Background: </strong>Stress urinary incontinence (SUI) following radical prostatectomy (RP) can impair quality of life (QoL). While surgical treatments have shown promising short-term results, data on long-term patient-reported outcomes remain limited.</p><p><strong>Objectives: </strong>To evaluate symptom burden, perceived improvement, and health-related quality of life (HRQoL) at extended follow-up after adjustable male obturator system (ATOMS) surgery.</p><p><strong>Design: </strong>Retrospective questionnaire-based observational study.</p><p><strong>Methods: </strong>Men with post-RP SUI who underwent ATOMS implantation between 2012 and 2023 at a single tertiary centre were retrospectively identified (<i>n</i> = 111). Postoperative follow-up beyond the early postoperative period was conducted on an on-demand basis. Survivors (<i>n</i> = 99) were contacted and, following informed consent, completed the EPIC-26, RAND-12, and Patient Global Impression of Change questionnaires. Follow-up duration was defined as the time from ATOMS surgery to questionnaire completion.</p><p><strong>Results: </strong>Eighty-three patients participated (median age: 75 years; median follow-up: 87 months). At follow-up, 66% reported perceived improvement. Perceived improvement correlated with higher RAND-12 physical and mental scores. Pad use negatively correlated with both physical and mental HRQoL (<i>r</i> = -0.4, <i>p</i> < 0.001). Prior radiotherapy and higher BMI were associated with poorer EPIC-26 incontinence scores. RAND-12 scores were comparable to age-matched general population data. Device removal did not significantly impact HRQoL scores. At final follow-up, only 11% used were completely pad-free.</p><p><strong>Conclusion: </strong>ATOMS surgery was associated with symptom improvement and favourable quality-of-life outcomes for most patients. In the context of an on-demand postoperative follow-up strategy without routine scheduled refilling, continence outcomes likely reflect the management model employed, and structured reassessment and refilling may therefore serve to optimise long-term results.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261442654"},"PeriodicalIF":3.5,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative AI in urology: rethinking patient counselling and shared decision-making - a scoping review from the European Association of Urology Patient Office.","authors":"Clara Cerrato, Francesco Ripa, Michael R van Balken, Eamonn T Rogers, Bhaskar K Somani","doi":"10.1177/17562872261441968","DOIUrl":"https://doi.org/10.1177/17562872261441968","url":null,"abstract":"<p><strong>Background: </strong>Shared decision-making (SDM) in urology faces challenges including limited health literacy, language barriers, and time constraints that can compromise informed consent and treatment adherence. Generative artificial intelligence (GAI), particularly large language models, offers opportunities to personalise patient education and enhance SDM.</p><p><strong>Objective: </strong>To evaluate the role of GAI applications in SDM for patients with urological conditions.</p><p><strong>Eligibility criteria: </strong>Peer-reviewed observational studies, validation studies, or mixed-methods studies evaluating GAI (e.g., large language models, AI chatbots) in patient communication, education, counselling, or SDM for urological conditions were included. Editorials, opinion pieces, conference abstracts, and non-English language publications were excluded.</p><p><strong>Source of evidence: </strong>PubMed, Embase, Cochrane Library, and Web of Science databases were comprehensively searched through June 2025. Study assessments: Newcastle-Ottawa Scale, the STROBE or the AGREE II as per study type.</p><p><strong>Charting methods: </strong>Charting methods was performed by using a standardised form. Outcomes of interest included accuracy of GAI-generated information, patient understanding, satisfaction, and decisional conflict.</p><p><strong>Results: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, 18 observational studies (2023-2025) were included, comprising 310 patients in real-world settings plus hundreds of simulated queries across diverse urological conditions. GAI demonstrated moderate to high accuracy (52%-95%) for guideline-based information, with optimal performance in disease-specific patient education. A prospective comparative study showed 27% reduction in consultation time and improved patient understanding with ChatGPT-4 assistance. Limitations emerged including poor performance in emergencies and complex oncological counselling, and readability issues with content written at a college level (mean Flesch-Kincaid Grade Level 13.5). Most studies evaluated ChatGPT versions, limiting generalizability.</p><p><strong>Conclusions: </strong>GAI could enhance and potentially transform SDM in urology with appropriate clinical oversight and human-in-the-loop governance. Currently, GAI is useful for consultation preparation and patient education, while maintaining physician expertise for complex scenarios. Future implementation should prioritise patient safety, equitable access, and environmental sustainability while developing speciality-specific models and clinician education programmes.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261441968"},"PeriodicalIF":3.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of apparent diffusion coefficients for prostate cancer in patients with PI-RADS 4-5 lesions: a retrospective analysis.","authors":"Xiaoyu Bai, Yuhan Chen, Lei Yuan, Shengjun Xu, Zhengxia Zhu, Wenya Mo, Jun Xiao, Changming Wang","doi":"10.1177/17562872261442021","DOIUrl":"https://doi.org/10.1177/17562872261442021","url":null,"abstract":"<p><strong>Background: </strong>While prostate biopsy is the standard diagnostic approach for Prostate Imaging-Reporting and Data System (PI-RADS) 4-5 lesions, some of these biopsies yield negative results.</p><p><strong>Objective: </strong>To determine the optimal minimum apparent diffusion coefficient (ADCmin) and prostate-specific antigen density (PSAD) threshold and develop a quantitative diagnostic standard that would enhance the diagnostic accuracy.</p><p><strong>Design and methods: </strong>The study included 361 patients who met the criteria and had undergone prostate biopsy between January 2021 and December 2024. Comprehensive clinical information was collected. Following the standardization of the region of interest protocol, apparent diffusion coefficient was measured for all PI-RADS 4-5 lesions. Univariate and multivariate logistic regression analyses were employed to identify independent predictors, and diagnostic efficacy was assessed using receiver operating characteristic curves and the area under the curve (AUC).</p><p><strong>Results: </strong>Of the 361 patients, 252 (69.8%) were diagnosed with clinically significant prostate cancer (csPCa), and 109 (30.2%) were diagnosed with clinically insignificant prostate cancer and non-prostate cancer. Multivariate analysis revealed PSAD and ADCmin to be independent predictors of csPCa. The AUC values of PSAD and ADCmin for diagnosing csPCa were 0.797 (95% CI: 0.751-0.837) and 0.777 (95% CI: 0.731-0.819), respectively. Applying the criterion of \"PSAD ⩾ 0.35 ng/mL² and ADCmin < 0.575 × 10^-3 mm²/s\" was found to have a high positive predictive value (94.2%) and a high specificity (91.7%) for csPCa in PI-RADS 4-5 lesions. Applying the criterion of \"PSAD ⩾ 0.35 ng/mL² or ADCmin < 0.575 × 10^-3 mm²/s\" substantially increased the negative predictive value for csPCa to 80.0% for PI-RADS 5 lesions.</p><p><strong>Conclusion: </strong>The results demonstrate that the ADCmin exhibits high diagnostic accuracy for detecting csPCa in patients with PI-RADS 4-5 lesions. Furthermore, diagnostic criteria were established for patients based on PSAD and ADCmin to aid in clinical decision-making regarding prostate biopsy.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261442021"},"PeriodicalIF":3.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocannabinoid responses to relief of obstruction in acute injured kidney: a prospective observational study.","authors":"Ariel Rothner, Sharon E Fishberg, Liad Hinden, Eyal Atias, Alina Nemirovski, Ofer N Gofrit, Joseph Tam, Guy Hidas","doi":"10.1177/17562872261442624","DOIUrl":"https://doi.org/10.1177/17562872261442624","url":null,"abstract":"<p><strong>Background: </strong>The endocannabinoid system (ECS) regulates homeostasis, inflammation, and organ-specific function. In the kidney, ECS activity modulates renal hemodynamics, and its overactivation is linked to chronic injury. However, the importance of the ECS involvement in acute kidney injury (AKI) remains unclear. This study aimed to characterize changes in circulating endocannabinoid (eCB) levels before and after relief of upper urinary tract obstruction (UUTO), to better understand ECS dynamics during acute renal dysfunction. These findings may inform the development of novel biomarkers and therapeutic targets for renal injury.</p><p><strong>Objectives: </strong>To characterize changes in circulating eCB levels before and after relief of UUTO, and to compare responses between patients with and without AKI.</p><p><strong>Design: </strong>Prospective observational cohort with paired, within-person sampling.</p><p><strong>Methods: </strong>Patients presenting to the emergency department with acute renal colic due to obstructive urolithiasis who underwent kidney decompression within 24 h were prospectively enrolled. Clinical, laboratory, and imaging data plus paired blood samples for eCB analysis were collected pre and post-drainage. Patients were divided into two groups: those who had AKI at presentation, and non-AKI controls. Serum eCBs were quantified, and fold changes compared using nonparametric analysis.</p><p><strong>Results: </strong>Twenty-two patients enrolled (10 had AKI and 12 served as non-AKI controls). Serum <i>N</i>-acylethanolamines (NAEs) showed divergent responses between the two groups. In AKI, <i>N</i>-arachidonoylethanolamine (AEA), <i>N</i>-palmitoylethanolamine, and <i>N</i>-oleoylethanolamine increased following drainage (<i>p</i> = 0.06, 0.008, 0.08). In contrast, patients without AKI demonstrated a reduction in NAE levels, with a significant AEA drop (<i>p</i> = 0.03) after obstruction relief. Notably, the fold-change in NAE levels post-drainage was significantly higher in patients with AKI compared to those without AKI.</p><p><strong>Conclusion: </strong>Circulating NAEs increase following relief of obstruction in patients with acute renal dysfunction, suggesting a potential role for ECS activation in the pathophysiology of UUTO-induced kidney injury. These findings highlight the ECS as a promising target for further investigation as a possible therapeutic avenue in AKI.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261442624"},"PeriodicalIF":3.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of lower urinary tract symptoms and health-related quality of life in patients undergoing ureteral rest prior to ureteral reconstruction.","authors":"Jonathan Rosenfeld, Aurash Naser-Tavakolian, Devin Boehm, Rebecca Arteaga, Aidan Raikar, Jaewoo Kim, Emily Ji, Ziho Lee","doi":"10.1177/17562872261436896","DOIUrl":"https://doi.org/10.1177/17562872261436896","url":null,"abstract":"<p><strong>Background: </strong>Ureteral rest refers to the removal of hardware across a ureteral stricture, allowing for stricture maturation and stabilization, before ureteral reconstruction.</p><p><strong>Objectives: </strong>We aimed to assess the potential impact of ureteral rest on lower urinary tract symptoms (LUTS) and health-related quality of life (HRQOL) in patients undergoing ureteral rest.</p><p><strong>Design: </strong>Prospective, longitudinal, self-controlled study.</p><p><strong>Methods: </strong>We included patients undergoing ureteral reconstruction between April 2022 and April 2025. We defined ureteral rest as replacing an indwelling double-J stent (DJS) with a percutaneous nephrostomy tube (PCN) prior to ureteral reconstruction. Primary outcomes were patient-reported LUTS (via International Prostate Symptom Score) and HRQOL (via Patient-Reported Outcomes Measurement Information System 29 v2.0). The secondary outcome was the incidence of urinary tract infections (UTIs). Questionnaires were completed prior to initiating ureteral rest (with a DJS) and after at least 3 weeks of ureteral rest (with a PCN). Continuous and categorical variables were compared using paired t-tests and chi-squared tests, respectively.</p><p><strong>Results: </strong>Thirty-five patients met our study's inclusion criteria. With regard to LUTS, patients undergoing ureteral rest were found to have reduced urinary frequency (<i>p</i> = 0.001), straining (<i>p</i> = 0.03), and urgency (<i>p</i> = 0.0002). With regard to HRQOL, patients undergoing ureteral rest were found to have improved sleep disturbance (<i>p</i> = 0.04). There was no difference in UTI rates before and after ureteral rest (<i>p</i> = 0.48).</p><p><strong>Conclusion: </strong>Patients undergoing ureteral rest prior to ureteral reconstruction may experience improvements in LUTS without compromising HRQOL outcomes or increasing the risk of UTIs.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261436896"},"PeriodicalIF":3.5,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13039622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stone displacement with combined Sotn ureteroscopy and flexible ureteroscopy for lower calyx stones ⩽20 mm: a retrospective comparative study.","authors":"Jianping Zhang, Mengqing Li, Shaomei Lin, Xiaoxia Wu, Qinhua Guo, Haiying Chen, Ming Lin, Zihuang Hong, Rongkai Lin, Lingfeng Zhu","doi":"10.1177/17562872261423750","DOIUrl":"https://doi.org/10.1177/17562872261423750","url":null,"abstract":"<p><strong>Background: </strong>The lower calyx is the most common site for kidney stones. While minimally invasive, flexible ureteroscopic lithotripsy often yields suboptimal stone-free rates (SFR) for lower calyx stones due to anatomical constraints and limited endoscope deflection.</p><p><strong>Objectives: </strong>To evaluate the efficacy and safety of a novel technique that combines Sotn ureteroscopy (Sotn-URS) with flexible ureteroscopy (fURS), involving stone displacement before lithotripsy, for managing lower calyx stones ⩽20 mm.</p><p><strong>Design: </strong>A retrospective comparative study complemented by in vitro simulation experiments.</p><p><strong>Methods: </strong>An in vitro model assessed the impact of a 200 µm laser fiber, a 365 µm fiber, a 1.7 Fr stone retrieval basket, and a flexible ureteral sheath on the deflection of a single-use fURS. In all, 240 patients with lower calyx stones (⩽20 mm) were allocated to either the experimental group (<i>n</i> = 114) or the control group (<i>n</i> = 126). The experimental group underwent combined Sotn-URS and fURS with basket-assisted stone displacement to the kidney pelvis or upper ureter before laser lithotripsy. The control group underwent conventional in situ lithotripsy using fURS alone. Outcomes, including operative time, SFR (immediate and at 4 weeks), surgeon comfort (Borg scale), first-pass sheath placement success, and complications, were compared.</p><p><strong>Results: </strong>The maximum deflection angle of the fURS alone was 295.7°. Insertion of a 365 µm fiber significantly reduced this angle to 270.1°, while a 200 µm fiber or basket had minimal impact (293.3° and 293.4°, respectively). Compared with control group, the experimental group demonstrated significantly higher immediate SFR (85.1% vs 73.0%, <i>p</i> < 0.05) and 4-week SFR (91.2% vs 81.7%, <i>p</i> < 0.05), along with shorter total operative time (51.7 vs 70.4 min, <i>p</i> < 0.05) and fURS intrarenal time (22.2 vs 52.2 min, <i>p</i> < 0.05). Surgeon comfort was better (Borg score 0.63 vs 2.9, <i>p</i> < 0.05), and the rate of ureteral mucosal injury was lower (3.5% vs 11.1%, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>The stone displacement technique utilizing combined Sotn-URS and fURS is an efficient and safe surgical approach for lower calyx stones ⩽20 mm. It uses the stable access and efficient lithotripsy of rigid Sotn-URS and the flexibility of fURS for stone displacement, resulting in improved stone clearance rates, reduced operative time, and lower ureteral injury risk.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261423750"},"PeriodicalIF":3.5,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13039562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of PSMA-PET imaging technology in diagnosing and staging of prostate cancer: a systematic review.","authors":"Chiranjeev Sanyal, Ricardo Rendon","doi":"10.1177/17562872261436874","DOIUrl":"10.1177/17562872261436874","url":null,"abstract":"<p><strong>Background: </strong>Prostate-specific membrane antigen (PSMA) PET is becoming the preferred imaging technique for prostate cancer (PCa) because of its superior sensitivity and specificity compared to traditional imaging methods. This article evaluates the methodological and reporting quality of literature regarding the cost-effectiveness of PSMA-positron emission tomography (PET)/computed tomography (CT) or MRI for detecting and staging PCa.</p><p><strong>Objective: </strong>To describe the methodological and reporting quality of the published cost-effectiveness studies on PSMA-PET.</p><p><strong>Methods: </strong>MEDLINE and EMBASE were searched from inception to December 05, 2025. Two researchers independently screened all retrieved articles according to inclusion and exclusion criteria. Studies were appraised for methodological quality using the Quality of Health Economic Studies checklist and for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards checklist.</p><p><strong>Results: </strong>A total of seven studies were examined, representing both private and public healthcare systems. Overall, these studies demonstrate high methodological and reporting quality. When compared to existing imaging technologies or standard care practices, PSMA-PET/CT or MRI is cost-effective within country-specific willingness-to-pay thresholds.</p><p><strong>Conclusion: </strong>Cost-effectiveness evaluations may not be widely generalizable due to significant variability among geographical regions concerning resource availability, costs, morbidity and mortality, and standards of practice. As PSMA-PET/CT imaging technology becomes more widely available in additional countries in the coming years, we expect to generate more country-specific data.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261436874"},"PeriodicalIF":3.5,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of large language models in interpreting urological clinical guidelines: a comparative study with expert evaluation.","authors":"Ángel Borque-Fernando, Denis Navarro, Manuel Doblare, Luis M Esteban, Daniel Perez-Fentes, Mario Álvarez-Maestro, Rafael A Medina-López, Oscar Rodríguez Faba, José Rubio-Briones, Sergio Fernández-Pello, Jesús María Fernández-Gómez, Tomás Fernández Aparicio, Félix Guerrero Ramos, Laura Izquierdo, José Luis Álvarez-Ossorio Fernández","doi":"10.1177/17562872261436905","DOIUrl":"10.1177/17562872261436905","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) are increasingly being explored to supporting evidence-based decision-making in urology, but their accuracy in interpreting and applying clinical guidelines remains uncertain.</p><p><strong>Objectives: </strong>We aimed to evaluate the ability of LLMs to interpret and apply clinical guidelines across the full spectrum of major urological cancers.</p><p><strong>Design: </strong>This expert-validated study evaluated six configurations of three top LLMs (Claude, Gemini, and ChatGPT) using 25 structured questions for each of the seven major urological cancers: prostate cancer, upper tract urothelial carcinoma, muscle-invasive and non-muscle-invasive bladder cancer, renal cell carcinoma, penile cancer, and testicular cancer.</p><p><strong>Methods: </strong>Both simple and rephrased prompts were used to assess the impact of prompt engineering on response quality. All figures and tables from the English-language EAU guidelines were systematically converted into plain, structured text and peer reviewed by multidisciplinary experts before evaluating the LLM responses. Each response was independently rated by 9-11 uro-oncology specialists using a five-point Likert scale (1: incorrect/unacceptable, 5: optimal), resulting in 10,500 evaluations.</p><p><strong>Results: </strong>Claude achieved the highest overall accuracy, with 45.9% of responses rated as optimal (Likert 5) and 87% as optimal/acceptable (Likert 4-5). Tumor-specific performance peaked in muscle-invasive bladder (56.7% optimal, 93% optimal/acceptable), penile (49.5%, 95%), and testicular cancer (60.9%, 94%). Gemini and ChatGPT showed lower optimal rates but acceptable performance (68%-70% optimal/acceptable). Rephrased prompts did not consistently outperform simple versions. All models showed acceptable accuracy, but the results should be interpreted cautiously due to recency bias and fast LLM tech evolution.</p><p><strong>Conclusion: </strong>This study demonstrates the value of rigorous plain language adaptation and expert validation in benchmarking LLMs, supporting their potential as decision-support tools in uro-oncology.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261436905"},"PeriodicalIF":3.5,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 poor kidney function in patients with emphysematous pyelonephritis: a retrospective observational study.","authors":"Anupam Choudhary, Kasi Viswanath Gali, Surag K R, Anshuman Singh, Abhijit Shah, Krishnakanth A V B, Sunil Pillai, Padmaraj Hegde","doi":"10.1177/17562872261429824","DOIUrl":"10.1177/17562872261429824","url":null,"abstract":"<p><strong>Background: </strong>Emphysematous pyelonephritis (EPN) is a well-known clinical condition characterized by an aggressive, gas-forming infection of the kidney caused by uropathogenic bacteria. There is growing interest in identifying the effects of EPN on long-term renal function and the factors that can help predict its impact.</p><p><strong>Objectives: </strong>This study evaluated risk factors for the development of poorly functioning kidneys (PFK) in patients diagnosed with EPN.</p><p><strong>Design: </strong>A retrospective study was conducted at a university teaching hospital on patients with EPN from January 2019 to December 2024.</p><p><strong>Methods: </strong>Data were collected from the prospectively maintained patient records, and patient demographics, comorbidities, clinical presentation, laboratory investigations, imaging characteristics, and interventions were analyzed. PFKs were defined as those with less than 15% differential function on radionuclide renography performed at follow-up. Data were analyzed using SPSS version 23 (IBM Corp.). A <i>p</i>-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 151 patients met the eligibility criteria. PFK was present in 23 patients (15.2%) on follow-up. Univariate analysis revealed random blood sugar (RBS) at presentation >200 mg/dL (<i>p</i> < 0.0001), >50% parenchymal involvement on imaging (<i>p</i> < 0.00001), Huang-Tseng Class 3b (<i>p</i> < 0.00001), and persistence of gas in the renal parenchyma on follow-up imaging (<i>p</i> < 0.0001) to be significantly associated with the development of PFK. Multivariate Analysis revealed that >50% parenchymal involvement on initial imaging was an independent and significant predictor of PFK.</p><p><strong>Conclusion: </strong>EPN is a fulminant renal infection with a high risk of renal functional deterioration. Renal parenchymal involvement of >50% on initial imaging emerged as the most significant and independent predictor of poor renal function. Additional contributory factors included RBS >200 mg/dL, Huang-Tseng Class 3b, and persistence of gas in the renal parenchyma on follow-up. Recognizing these clinical and radiological predictors can support early risk stratification, guide patient counseling, and inform individualized management strategies aimed at preserving renal function.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261429824"},"PeriodicalIF":3.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}