Translational andrology and urology最新文献

{"title":"Delays in male infertility evaluation and their financial and emotional impact on couples.","authors":"Jordan G Kassab, Amelia G Oppenheimer, Angelica Garcia Keeme-Sayre, Blair T Stocks, Larry I Lipshultz","doi":"10.21037/tau-2026-0246","DOIUrl":"https://doi.org/10.21037/tau-2026-0246","url":null,"abstract":"<p><strong>Background: </strong>Although male and female factors contribute equally to infertility, evaluation pathways frequently prioritize female-focused care, delaying appropriate assessment of male-factor infertility. This study aims to assess the impact of delayed urologic care for male-factor infertility couples by assessing emotional and financial well-being and evaluating how gendered assumptions influence the diagnostic and treatment pathways in their care.</p><p><strong>Methods: </strong>An anonymous, electronic Research Electronic Data Capture (REDCap) survey was distributed from January 2023 to June 2025 to patients seeking infertility services. The survey included both quantitative and qualitative items addressing participants' healthcare journey, timing of male-factor evaluation, and related burdens. Descriptive statistics, Chi-square tests, logistic regression, and thematic analysis were performed.</p><p><strong>Results: </strong>Among 226 surveyed couples, 26.0% first sought gynecologic care and 10.2% consulted a reproductive endocrinologist before urologic evaluation. Time spent addressing only female-factor infertility ranged from 2 months to 6 years. Overall, 38.3% regretted not seeking urologic care sooner. Significant associations were found between regret and both initiating care with female providers and financial burden. Patients reported out-of-pocket costs between $1,500 and $300,000 prior to male evaluation, with several citing the need to take out loans to cover the cost of treatments. The qualitative responses highlighted fertility treatment delays, confusion surrounding the role of urologists in the fertility journey, and high costs as major concerns.</p><p><strong>Conclusions: </strong>Our findings highlight the urgent need to address gender bias in infertility care as delays in evaluating male-factor infertility led to significant emotional and financial harm, inefficient use of healthcare resources, and a disproportionate burden on women. A paradigm shift toward an earlier, inclusive, couple-based evaluation is essential to advancing equitable reproductive care in the face of a global fertility crisis.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 9","pages":"329"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184402","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":"Is the density of transition zone prostate tissue truly 1 gram per milliliter?-an evaluation of HoLEP specimens.","authors":"Nabila Reem Khondakar, Amir Patel, Jessica Helon, Alyssa McDonald, Alla Fadl-Alla, Jenny Guo, Amy E Krambeck, Perry Xu","doi":"10.21037/tau-2026-0454","DOIUrl":"https://doi.org/10.21037/tau-2026-0454","url":null,"abstract":"<p><strong>Background: </strong>Prostate volume is assumed to equal prostate weight (PW), based on a 1:1 conversion between the milliliter (mL) and gram (g). While the 1:1 conversion holds for pure water, the density of transitional zone prostate tissue has not been studied. The aim of this study was to evaluate prostate density (PD) and the factors that affect it.</p><p><strong>Methods: </strong>This was an experimental <i>in vitro</i> study of holmium laser enucleation of the prostate (HoLEP) specimens weighed intraoperatively. Morcellated transition zone tissue was collected. The PW was measured by sterile water displacement. The volume displaced by the tissue was used to measure volume and density. Statistical analysis was performed using correlation analysis and the Wilcoxon rank-sum test. Descriptive statistics were reported as medians with bootstrap-calculated interquartile ranges (IQR).</p><p><strong>Results: </strong>Specimen data were collected from 50 consecutive HoLEP patients, of whom 45 had complete data. Median resected intraoperative PW was 71 g (IQR, 56-89). Intraoperatively measured prostate volume was 74.2 mL (IQR, 60-89.6). Calculated PD was 0.95 (0.92-0.98). Prostate volume modestly overestimated resected PW by 3.35 mL (95% confidence interval: 1.10-5.35<b>,</b> P<i>=</i>0.005). Finasteride use, prior benign prostatic hyperplasia (BPH) surgery, and cancerous tissue were not associated with PD. Prostates larger than 100 mL on preoperative imaging had a higher PD compared to smaller prostates. Denser prostate tissue was associated with longer morcellation and enucleation times, and higher laser energy utilization.</p><p><strong>Conclusions: </strong>In transitional zone prostate tissue collected from HoLEP specimens, PW was largely consistent with prostate volume, supporting the notion of 1:1 conversion. However, this did not hold for larger prostates, which were denser and exhibited greater variation in prostate volume. Correlation between PD and pathology needs to be further studied.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 9","pages":"328"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184520","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":"Low free testosterone and anterior urethral stricture disease: a coherent signal still in search of a causal test.","authors":"Leonidas Karapanos, Daniel Porres","doi":"10.21037/tau-2026-0741","DOIUrl":"https://doi.org/10.21037/tau-2026-0741","url":null,"abstract":"","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 9","pages":"320"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184564","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":"Flow cytometry sperm apoptosis test can predict sperm DNA fragmentation and can be used as an effective and easy-to-perform screening method for males from infertile couples.","authors":"Jan Novák, Viktor Vik, Tomáš Fürst, Vojtěch Thon, Zuzana Krátká","doi":"10.21037/tau-2026-0639","DOIUrl":"https://doi.org/10.21037/tau-2026-0639","url":null,"abstract":"<p><strong>Background: </strong>Conventional sperm analysis is the gold standard for male fertility assessment. However, since the basic examination consists of microscopic evaluation of native ejaculate, some sperm pathologies might be missed during this examination. The sperm DNA fragmentation test is currently considered the most precise indicator of the sperm potential to fertilize an oocyte both naturally and by assisted reproductive technologies (ART). Irrespective of which method is used, sperm DNA fragmentation testing requires special technical equipment and chemicals together with skilled laboratory staff, and is usually time-consuming and costly. The primary aim of the presented study was to assess whether the flow cytometry sperm apoptosis test (FACS-APO) can predict sperm DNA fragmentation as measured by the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay.</p><p><strong>Methods: </strong>In this retrospective observational study, we analysed 971 semen samples from 688 men who underwent concurrent conventional sperm analysis, FACS-APO, and TUNEL-based sperm DNA fragmentation testing at a single in vitro fertilization centre between January 2019 and December 2024. Non-parametric Spearman correlation and Kruskal-Wallis tests were used to assess associations between sperm DNA fragmentation, FACS-APO parameters, and conventional sperm analysis variables. A linear regression model predicting sperm DNA fragmentation from age and the percentage of viable sperm on FACS-APO was developed, and its diagnostic accuracy for a 20% sperm DNA fragmentation cut-off was evaluated.</p><p><strong>Results: </strong>A significant correlation was found between the percentage of sperm DNA fragmentation and the percentage of late apoptotic/necrotic sperm (ρ=0.38, P<0.001), and a significant negative correlation was found between the percentage of sperm DNA fragmentation and the percentage of viable sperm (ρ=-0.39, P<0.001). The correlation between the percentage of sperm DNA fragmentation and the percentage of early apoptotic sperm was less significant (ρ=0.10, P=0.002). Among conventional sperm analysis parameters, sperm concentration, total sperm count, and progressive motility each showed a significant correlation with sperm DNA fragmentation (P<0.001). A simple linear model for calculation of sperm DNA fragmentation was created: sperm DNA fragmentation (%) = 23 + 0.32 × age (years) - 0.35 × viable sperm (%). Based on this model, males at higher risk of having high levels of sperm DNA fragmentation might be selected, which ultimately may save substantial time and financial resources.</p><p><strong>Conclusions: </strong>The flow cytometry sperm apoptosis test is an inexpensive, accurate, and easy-to-perform method and might be used effectively as a screening tool to select males at higher risk of having high levels of sperm DNA fragmentation.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 9","pages":"326"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184581","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":"Filling the information gap: a validated comparison of ChatGPT, Gemini, and Claude for penile cancer patient education.","authors":"Jeffery Yang, Ymer Bushati, Sarah Lorger, Jeremy Saad, Prem Rathore","doi":"10.21037/tau-2026-0603","DOIUrl":"https://doi.org/10.21037/tau-2026-0603","url":null,"abstract":"<p><strong>Background: </strong>ChatGPT, Gemini, and Claude are three large language models (LLMs) increasingly consulted by patients researching a new cancer diagnosis. Penile cancer is rare, stigmatised, and dominated by decisions around organ preservation and sexual function, which makes the quality of patient-facing information particularly consequential. The aim of this study was to assess the quality of responses generated by these LLMs to patient-oriented questions on penile cancer.</p><p><strong>Methods: </strong>Fourteen questions reflecting common patient information needs were adapted from established educational resources and refined by senior urology consultant review. Each query was presented to ChatGPT, Gemini, and Claude using an identical patient-centred prompt. Responses (n=42) were anonymised and randomly ordered before being independently reviewed in a consensus meeting by a urology panel using the Quality Analysis of Medical Artificial Intelligence (QAMAI) framework. Comparative analysis used the Friedman test with Bonferroni-corrected pairwise Wilcoxon signed-rank testing.</p><p><strong>Results: </strong>Mean total QAMAI scores were 22.7 for ChatGPT (median, 23; range, 17 to 25), 22.6 for Claude (median, 23; range, 18 to 24), and 17.0 for Gemini (median, 17.5; range, 14 to 20), corresponding to moderate quality for ChatGPT and Claude and the boundary of poor and moderate quality for Gemini. The difference across models was significant (Friedman χ²=18.78; P<0.001). ChatGPT and Claude each significantly outperformed Gemini (both adjusted P=0.004) but did not differ from one another (adjusted P>0.99). ChatGPT produced the clearest responses and Claude the most complete, while Gemini scored lowest in every domain, most strikingly for surgery and organ preservation (14.0 <i>vs.</i> 23.7 and 23.0). No response provided citations or referred readers to external sources of information.</p><p><strong>Conclusions: </strong>ChatGPT and Claude delivered broadly equivalent, moderate-to-good-quality information on patient-derived penile cancer questions, and both clearly outperformed Gemini, which frequently produced incomplete answers in the surgical and organ preservation domain. The universal absence of source citation is a clinically relevant limitation. These tools should be regarded as a supplement to, rather than a substitute for, specialist consultation.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 9","pages":"340"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184589","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":"An O-glycosylation-based prognostic signature for biochemical recurrence in prostate cancer identifies <i>GALNTL6</i> as a potential promoter of malignant phenotypes.","authors":"Yize Li, Zeheng Tan, Haiyin Xiao, Zhenjie Wu, Biyan Wen, Chenyu Liang, Sian Chen, Weicheng Tian, Huichan He, Jianheng Ye, Weide Zhong","doi":"10.21037/tau-2026-0315","DOIUrl":"10.21037/tau-2026-0315","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Prostate cancer (PCa) is frequently diagnosed in men, and biochemical recurrence (BCR) remains a persistent problem after clinical treatment. Commonly used indicators do not identify patients who are likely to relapse early. Protein O-linked glycosylation is an important post-translational modification involved in cancer progression, but its prognostic relevance and regulatory mechanisms in PCa remain insufficiently understood. &lt;i&gt;GALNTL6&lt;/i&gt;, which encodes polypeptide N-acetylgalactosaminyltransferase-like 6, is putatively involved in mucin-type protein O-linked glycosylation and remains poorly characterized in PCa. To address this issue, we integrated several public transcriptomic cohorts with matched clinical data to develop an O-glycosylation-related prognostic model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Different machine-learning approaches were tested during model development. The final score O-glycosylation scores (OGs) was then examined for risk classification, nomogram construction, and prediction of drug sensitivity. &lt;i&gt;GALNTL6&lt;/i&gt; was chosen for experimental validation in DU145 and 22Rv1 cells using both overexpression and knockdown designs, followed by assays for cell proliferation, migration, and invasion. RNA sequencing was also carried out to investigate downstream molecular changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The O-glycosylation signature consistently stratified patients into distinct risk groups across multiple independent cohorts (P&lt;0.01), and the derived risk score remained an independent predictor of BCR [hazard ratio (HR) &gt;1.48, P&lt;0.05]. A nomogram integrating the O-glycosylation signature with clinicopathological variables achieved good performance in estimating 1-, 3-, and 5-year BCR probabilities [area under the curve (AUC): 0.747-0.863]. Drug-sensitivity analysis suggested that patients with different OGs scores may show distinct predicted responses to candidate agents, including AZD7762, a checkpoint kinase inhibitor, and tigecycline, a glycylcycline antibiotic with reported antitumor activity. &lt;i&gt;GALNTL6&lt;/i&gt; emerged as the central gene within the signature, and its increased expression was associated with unfavorable prognosis, more advanced disease status, and higher prostate-specific antigen (PSA) levels. Functionally, silencing &lt;i&gt;GALNTL6&lt;/i&gt; reduced PCa cell growth and motility, whereas enforced &lt;i&gt;GALNTL6&lt;/i&gt; expression produced the opposite effects (P&lt;0.05). Transcriptomic analysis further indicated that &lt;i&gt;GALNTL6&lt;/i&gt; overexpression was associated with PI3K-AKT signaling and antioxidant-response genes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study establishes an O-glycosylation-related prognostic model for BCR risk stratification in PCa and identifies &lt;i&gt;GALNTL6&lt;/i&gt; as a potential promoter of malignant phenotypes. These findings suggest that &lt;i&gt;GALNTL6&lt;/i&gt; may be associated with AKT pathway activity and oxidative-stress-related transcriptional programs, although further mechanisti","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 8","pages":"285"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the uric acid-to-high-density lipoprotein cholesterol ratio with uric acid stones: a single-center retrospective cohort study.","authors":"Yu Xia, Tao Huang, Xi Liu, Binbin Ma","doi":"10.21037/tau-2026-0462","DOIUrl":"10.21037/tau-2026-0462","url":null,"abstract":"<p><strong>Background: </strong>Uric acid stones (UAS) are a common metabolically associated subtype of urolithiasis. Their formation is strongly driven by acidic urine and frequently coexists with dysglycemia and other cardiometabolic abnormalities. The serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR) is a readily available composite index reflecting uric acid burden and high-density lipoprotein (HDL)-related metabolic status. However, evidence linking UHR to composition-confirmed UAS in clinical practice remains limited. This study aimed to investigate the association between UHR and UAS.</p><p><strong>Methods: </strong>We retrospectively reviewed hospitalized patients who underwent stone-related surgery at a single center from October 2023 to December 2025. Postoperative stone composition was determined by Fourier-transform infrared spectroscopy (FTIR). UAS were defined when a uric acid-related component was the predominant stone component. UHR was calculated after converting serum uric acid and high-density lipoprotein cholesterol (HDL-C) to mg/dL, using the formula UHR (%) = [uric acid (mg/dL)/HDL-C (mg/dL)] × 100, and was analyzed as a continuous variable per 5-unit increase. Binary logistic regression was performed to evaluate the association between UHR and UAS. The multivariable model adjusted for age, sex, body mass index (BMI), diabetes mellitus (DM), hypertension, urinary pH, and urea. Exploratory DM-stratified models were adjusted for age and urinary pH, with Firth penalized logistic regression performed as a sensitivity analysis. Complete-case analysis was used for regression.</p><p><strong>Results: </strong>Overall, 485 patients were included. After excluding 23 patients with missing data required to calculate UHR, 462 complete cases (58 UAS) were analyzed in regression models. Compared with non-UAS patients, those with UAS had lower urinary pH and higher UHR. In the fully adjusted model, higher UHR was independently associated with greater odds of UAS [per 5-unit increase: odds ratio (OR) 1.64, 95% confidence interval (CI): 1.20-2.24]. In DM-stratified analyses, the association remained significant in both the non-DM subgroup (OR 1.74, 95% CI: 1.26-2.41) and the DM subgroup (OR 2.54, 95% CI: 1.37-4.71), with consistent findings in Firth sensitivity analyses.</p><p><strong>Conclusions: </strong>In a surgically treated cohort with FTIR-confirmed stone composition, higher UHR was independently associated with UAS and remained significant across DM strata. Given its routine availability, UHR may help prompt targeted metabolic evaluation in stone formers; prospective multicenter studies are warranted to validate its clinical utility.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 8","pages":"287"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956560","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":"Mapping the global landscape of robot-assisted upper urinary tract reconstruction: a comprehensive bibliometric analysis.","authors":"Wei Zuo, Zhihua Li, Kunlin Yang, Xinfei Li, Qi Tang, Liqun Zhou, Jian Lin, Xuesong Li","doi":"10.21037/tau-2026-0314","DOIUrl":"10.21037/tau-2026-0314","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted surgery has increasingly been applied to upper urinary tract reconstruction, offering technical advantages in selected complex cases. This bibliometric study aims to map the global research landscape, identify key contributors, and analyze emerging trends in robot-assisted upper urinary tract reconstruction.</p><p><strong>Methods: </strong>Publications related to robotic upper urinary tract reconstruction were retrieved from the Web of Science Core Collection. Bibliometric analysis was performed using R to evaluate publication trends, countries, institutions, authors, journals, and keywords.</p><p><strong>Results: </strong>A total of 1,104 publications on robotic upper urinary tract reconstruction published were included. Research output increased steadily, with rapid growth after 2020. The United States led in publications and collaboration, followed by China. The University of Chicago, New York University, and Peking University were the most productive institutions, and Journal of Endourology was the leading journal. Highly cited studies mainly focused on robotic pyeloplasty and ureteropelvic junction obstruction. Core topics included pyeloplasty, robotic surgery, pediatric reconstruction, and ureteral reimplantation. Recent trends show a shift toward complex ureteral reconstruction, with ureteroplasty, ureteral stricture, graft-based reconstruction, and single-port robotic surgery as emerging hotspots.</p><p><strong>Conclusions: </strong>Research on robotic upper urinary tract reconstruction has expanded rapidly, driven by a few leading countries and institutions. The focus has shifted from pyeloplasty and pediatric cases to more complex ureteral reconstruction. Emerging areas such as ureteroplasty, graft-based techniques, and single-port surgery are expected to shape future developments.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 8","pages":"281"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956574","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":"Dual-center development and external validation of machine learning models integrating PSA-derived and peripheral inflammatory markers for prostate cancer diagnosis.","authors":"Jing Yang, Qianshi Jiang, Yang Wang, Jiaquan Zhou, Guoping Li, Zuobing Yang, Xiangcheng Zhou, Bin Pu, Fanchang Zeng","doi":"10.21037/tau-2026-0678","DOIUrl":"10.21037/tau-2026-0678","url":null,"abstract":"<p><strong>Background: </strong>Prostate-specific antigen (PSA) has limited specificity for prostate cancer (PCa), particularly within the PSA gray zone (4-10 ng/mL), where benign and malignant conditions overlap. This study aimed to develop and evaluate logistic regression, decision tree, and extreme gradient boosting (XGBoost) models that combine PSA-derived variables with routinely available peripheral inflammatory markers, with a prespecified subgroup analysis of patients in the PSA gray zone.</p><p><strong>Methods: </strong>This retrospective dual-center study consecutively enrolled 317 newly diagnosed, treatment-naïve patients at Hainan General Hospital between January 2019 and December 2024, including 151 patients with PCa and 166 with benign prostatic hyperplasia (BPH). The PSA gray-zone subgroup comprised 116 patients (46 PCa and 70 BPH). Total PSA (tPSA), free PSA (fPSA), and routine blood-cell parameters were obtained from the first blood draw after admission and before biopsy, surgery, or anticancer treatment; the free-to-total PSA ratio (f/t PSA ratio), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) were calculated. Logistic regression, decision tree, and XGBoost models were developed using stratified 8:2 training/internal-validation splits. A separate cohort of 60 patients (30 PCa and 30 BPH) from a different institution was used for external validation. Direct area under the curve (AUC) comparisons were performed on a common internal-validation set using paired DeLong tests.</p><p><strong>Results: </strong>Among individual indicators, tPSA showed the highest AUC in the overall cohort (0.801), whereas the f/t PSA ratio showed the highest AUC in the gray-zone subgroup (0.683). The decision tree achieved AUCs of 0.903, 0.867, and 0.724 in the training, internal-validation, and external-validation sets, respectively; the corresponding XGBoost AUCs were 0.930, 0.933, and 0.781. On the common internal-validation set used for paired comparison, the AUCs were 0.811 for logistic regression, 0.867 for the decision tree, and 0.851 for XGBoost, with no significant between-model differences after multiple-comparison correction. In the gray-zone subgroup, the decision tree used the f/t PSA ratio as its primary split and had the highest optimism-corrected AUC (0.757), compared with XGBoost (0.649) and logistic regression (0.609).</p><p><strong>Conclusions: </strong>Models combining PSA-derived variables with peripheral inflammatory markers showed potential as complementary tools for PCa risk stratification, also within the PSA gray zone. No multivariable model demonstrated statistically superior discrimination in the paired comparison. The decision tree offered explicit threshold-based rules, but prospective multicenter evaluation and calibration assessment are required before clinical use.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 8","pages":"300"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956602","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":"A multicenter retrospective study of 108 men with urethral hemangioma.","authors":"Da-Chun Jin, Bo-Jun Li, Tao Li, Qu-Liang Zhong, Yue-Hai Xiao, Qiang Wang, Pei-He Liang, Peng Wang, Yan-Feng Li","doi":"10.21037/tau-2026-0347","DOIUrl":"10.21037/tau-2026-0347","url":null,"abstract":"<p><strong>Background: </strong>Male urethral hemangioma is a rare but highly under-recognized cause of sex-related hematuria and hematospermia. Existing evidence is limited to small case series. This study aimed to characterize the clinical features and long-term outcomes of male urethral hemangioma treated with cystourethroscopy followed by immediate endoscopic treatment, and to evaluate risk factors for recurrence and patient-reported outcomes (PROs).</p><p><strong>Methods: </strong>This retrospective multicentered cohort study included 108 men with urethral hemangioma from Affiliated Hospital of Guizhou Medical University and Army Medical Center from 2014 to 2025 with at least 3-month follow-up. Baseline characteristics, lesion location, perioperative variables, and follow-up data were collected. PRO failure was defined as any of: patient global impression of change as no change or worse, overall satisfaction ≤7 (out of 10), or fear-driven avoidance of sexual activity over the past 3 months. Conventional logistic regression was used to identify factors associated with PRO failure, and Firth penalized Cox proportional regression was applied to explore risk factors for recurrence.</p><p><strong>Results: </strong>Following cystourethroscopy and immediate endoscopic surgery, symptoms resolved within 6 weeks in 100% of patients, recurrence occurred in 8 (7.4%) cases with a median of 55 months follow-up. PRO failure occurred in 17 (15.7%) cases and was independently associated with baseline lower urinary tract symptoms (LUTS) [odds ratio 3.4 (1.089, 11.114), P=0.04], but not with age (P=0.12) or recurrence (P=0.41). Multiple lesions [hazard ratio 5.732 (1.044, 31.468), P=0.04] were independently associated with recurrence in Firth regression, whereas typical versus atypical location was not (P=0.31).</p><p><strong>Conclusions: </strong>Cystourethroscopy followed by immediate endoscopic treatment is a safe and effective one-step diagnostic-therapeutic strategy with low long-term recurrence and high patient satisfaction. Baseline LUTS and lesion multiplicity offer clinically relevant risk stratification for PROs and recurrence.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"15 8","pages":"277"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956632","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}