Urologia Internationalis最新文献

{"title":"A retrospective analysis of modern endoscopic surgery for nephrolithiasis: ECIRS with advantages.","authors":"Vincent Scheper, Joana Bläsius, Hubert Kübler, Charis Kalogirou, Marcel Schwinger","doi":"10.1159/uin/aewag038","DOIUrl":"https://doi.org/10.1159/uin/aewag038","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate the operative safety and clinical outcomes of endoscopic combined intrarenal surgery (ECIRS) compared to the established techniques (PCNL, mini-PCNL) treating kidney stones.</p><p><strong>Methods: </strong>Patients who underwent endoscopic surgery for kidney stones between 2013 and 2024 at the university hospital of Wuerzburg were divided into three (ECIRS, PCNL, mini-PCNL) groups and retrospectively analysed. Comparison was performed using t-, chi-square-tests and ANOVA.</p><p><strong>Results: </strong>A total of 185 patients were allocated to three groups and compared. Among them, 98 patients underwent standard PCNL, 48 patients were assigned to the mini-PCNL group, and 39 patients to the ECIRS group. Considering comparable characteristics regarding nephrolithiasis and postoperative complications, the ECIRS group demonstrated significantly shorter operative times (85 vs. 125 vs. 115min, p<0.001), fluoroscopy durations (3.7 vs. 7.7 vs. 5.8 min, p<0.001), and lengths of hospital stay (8.2 vs. 12.7 vs. 9.2 days, p<0.001) compared to PCNL and mini-PCNL. The stone-free rates showed a trend to be superior in the ECIRS group, while complication rates and the need for re-interventions within 30 days were comparable among the groups analysed. Additional benefits of ECIRS were identified in the subgroup analysis. In patients with multiple stones (two or more), subgroup analysis confirmed significant shorter operative and fluoroscopy times and shorter hospital stays with ECIRS, while also revealing better postoperative renal function and a trend toward higher stone-free rates compared to mini-PCNL.</p><p><strong>Conclusions: </strong>ECIRS technique is a safe and effective endoscopic option for managing complex kidney stones, offering reduced operative and fluoroscopy times as well as shorter hospital stays. Future studies with larger patient cohorts may further elucidate the advantages of the ECIRS approach and refine its indications to identify patients who would benefit most from this technique.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Candidal Bezoar in an SGLT2 Inhibitor User with an Indwelling Ureteral Stent: A Case Report and Review of Literatures.","authors":"Wei-An Chen, Hao Xiang Chen","doi":"10.1159/uin/aewag035","DOIUrl":"https://doi.org/10.1159/uin/aewag035","url":null,"abstract":"<p><p>Renal candidal bezoar is a rare cause of obstructive pyonephrosis and usually occurs in patients with diabetes mellitus, immunosuppression, urinary obstruction, or indwelling urinary devices. We report an 88-year-old man with type 2 diabetes treated with dapagliflozin, stage 3 chronic kidney disease, and a history of ureteral stricture managed with ureteral stenting who developed recurrent candidal pyonephrosis and extensive fungal bezoar involving the ureter and renal pelvis. Initial treatment at a referring hospital included percutaneous nephrostomy drainage, fluconazole therapy, ureteroscopic ureterotomy, and ureteral stent placement. The patient re-presented with fever and pyonephrosis and was presented to our emergency department. Dapagliflozin was discontinued, the ureteral stent was exchanged, and fluconazole with short course flucytosine was administered pending susceptibility testing. Cultures confirmed fluconazole-susceptible Candida albicans. Staged ureteroscopic debridement using forceps and aspiration achieved complete clearance, followed by renal functional recovery and clinical resolution. This case highlights the need to reassess medication-associated glycosuria, indwelling stent exposure, and mechanical source control in refractory upper-tract candidal bezoar. A review of reported cases suggests that drainage and antifungal therapy are essential, but active endoscopic, percutaneous, or surgical removal is frequently required when organized fungal material persists.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation and Comparison of Briganti, Partin, and MSKCC Nomograms for Predicting Lymph Node Metastasis in a Large Turkish Radical Prostatectomy Cohort.","authors":"Seref Coser, Melih Balci, Ali Yasin Ozercan, Mehmet Yildizhan, Yalcin Kizilkan, Burak Koseoglu, Unsal Eroglu, Ozer Guzel, Yilmaz Aslan, Altug Tuncel","doi":"10.1159/uin/aewag036","DOIUrl":"https://doi.org/10.1159/uin/aewag036","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess the predictive power of the \"Briganti\", \"Partin\" and \"Memorial Sloan Kettering Cancer Center\" (MSKCC) nomograms in the Turkish population.</p><p><strong>Methods: </strong>Between 2010 and 2021, 575 patients retrospectively evaluated in our center who underwent radical prostatectomy and bilateral pelvic lymph node dissection. The patients' lymph node invasion risk was calculated from every three nomograms and compared with the lymph node invasion rates. The general accuracy of the nomograms in predicting metastatic lymph node disease was measured by creating the characteristic ROC curve.</p><p><strong>Results: </strong>The average age of patients were 63,9 ± 6,7 (40-79) and lymph node involvement was present in 8.6% of all patients. Considering the 5% cut-off value according to the European Association of Urology guideline and 2% cut-off value based on National Comprehensive Cancer Network's guideline, the accuracies of the nomograms were 76.8% (95% Confidence Interval [CI]: 0.700-0.836, p<0.001) and 68.2% (95% CI: 0.623-0.742, p<0.001) for the Briganti nomogram; and 74.2% (95% CI: 0.684-0.818, p<0.001) and 77.6% (95% CI: 0.710-0.841, p<0.001) for the Partin nomogram, respectively. For the MSKCC nomogram, it was determined to be 75.1% (95% CI: 0.684-0.816, p<0.001) and 69.6% (95% CI: 0.638-0.754, p<0.001).</p><p><strong>Conclusion: </strong>All three nomograms demonstrated clinically relevant predictive accuracy in predicting lymph node metastasis. In particular, the Partin nomogram revealed the highest predictive power according to the NCCN criteria. These findings provide evidence for external validity of these nomograms for clinical use in the Turkish population.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Significance of Stone Culture in Endoscopic Upper Urinary Tract Stone Surgery: Its Association with Systemic Inflammatory Response Syndrome (SIRS) and Surgical Success.","authors":"Hakan Yildiz, Reha Ordulu, Emrah Küçük, Ekrem Akdeniz, Mahmut Ulubay, Mustafa Kemal Atilla","doi":"10.1159/uin/aewag037","DOIUrl":"https://doi.org/10.1159/uin/aewag037","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the results of stone culture and the correlation with urine cultures, stone composition, postoperative systemic inflammatory response syndrome (SIRS) and surgical outcomes.</p><p><strong>Methods: </strong>This prospective study included 115 patients undergoing endoscopic retrograde lithotripsy. Urine culture at initial presentation, intraoperative urine cultures, and stone cultures were obtained from patients, and the variables were compared according to stone culture positivity.</p><p><strong>Results: </strong>Stone culture positivity was determined in 8.7% of patients. The most frequently isolated microorganism, at 50%, was Candida albicans. Hydronephrosis grade (p = 0.034), length of hospital stay (p = 0.003), urine culture positivity at initial presentation (p = 0.003), and intraoperative urine culture positivity (p < 0.001) differed significantly according to stone culture positivity. The incidence of SIRS was higher in these patients (p = 0.037), while the stone-free rate was lower (p = 0.021). The most common chemical stone type, at 66.9%, was calcium oxalate, and no significant correlation was observed between stone composition and stone culture positivity.</p><p><strong>Conclusion: </strong>Stone culture positivity is associated with postoperative SIRS development and reduced surgical success. The study findings suggest that urinary stones may serve as a potential microbial reservoir, particularly in the presence of urinary obstruction, and that relying solely on urine culture at initial presentation may be insufficient for assessing postoperative infectious risk. Stone culture may be clinically valuable in terms of predicting postoperative risk and surgical success and of planning targeted antibiotic therapy particularly in patients with hydronephrosis.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex as a Trigger, Avoidance as the Consequence: Characterizing Post-Coital Recurrent UTI in Women.","authors":"Dor Golomb, Orit Raz","doi":"10.1159/uin/aewag034","DOIUrl":"https://doi.org/10.1159/uin/aewag034","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the clinical, behavioral, and treatment profiles of women with recurrent urinary tract infections (rUTIs) who identify sexual intercourse as a trigger, and to compare them with women whose rUTIs occur independently of sexual activity. This cross-sectional study utilized an anonymous, internet-based survey distributed via social media and women's health forums between May 2025 and March 2026. Participants were stratified into post-coital (PC) and non-post-coital (NPC) groups based on self-reported perception of a temporal relationship between intercourse and symptom onset, without clinical or microbiological confirmation. Comparative analysis was performed using chi-squared and Fisher's exact tests; because the two groups differed significantly in age, a pre-specified age-restricted subgroup analysis (18-35 years) was performed as an alternative to multivariable regression, which was not considered statistically robust given the sample size.</p><p><strong>Results: </strong>Of 82 respondents, 42 (51.2%) identified sexual intercourse as a UTI trigger. Comparison of PC and NPC women revealed that the post-coital phenotype was significantly more likely to avoid sexual intercourse (73.8% vs. 50.0%, p=0.046) and to report damage to their intimate relationships (59.5% vs. 35.0%, p=0.045). These differences persisted within the 18-35 age subgroup. Despite this additional burden, overall quality of life (QoL) impairment was high and statistically comparable across both groups (73.8% vs. 80.0%, p=0.69). Significant management gaps were identified specifically in the PC group: consistent pre-treatment urine culture performance was substantially lower (45.2% vs. 75.0%, p=0.012), and vaginal estrogen use was less frequent in eligible women (14.3% vs. 37.5%, p=0.031). Post-coital rUTI is associated with disproportionate sexual avoidance and relationship damage, independent of age and overall disease burden; given the cross-sectional design and self-reported group classification, these findings are best regarded as hypothesis-generating rather than as establishing a definitive clinical phenotype. Targeted clinical enquiry, consistent microbiological documentation, and proactive post-coital prophylaxis may help address the relational harm this condition appears to impose, pending confirmation in prospective studies.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Baseline Neutrophil-to-Lymphocyte Ratio and Clinicopathological Factors in a Multicenter Cohort of Urothelial Carcinoma Treated with Adjuvant Nivolumab.","authors":"Asuka Sano, Yuya Oishi, Gaku Ishikawa, Shunsuke Watanabe, Shinya Watanabe, Yoshihiro Tsuchiya, Ryoichi Maenosono, Yuki Yoshikawa, Kyosuke Nishio, Hirofumi Morinaka, Masanobu Saruta, Wataru Fukuokaya, Kyohei Watanabe, Hiromitsu Watanabe, Keita Tamura, Daisuke Motoyama, Takafumi Yanagisawa, Kiyoshi Takahara, Yutaka Yamamoto, Kazutoshi Fujita, Teruo Inamoto","doi":"10.1159/uin/aewag032","DOIUrl":"https://doi.org/10.1159/uin/aewag032","url":null,"abstract":"<p><strong>Background: </strong>Adjuvant nivolumab prolongs disease-free survival (DFS) after radical surgery for high-risk urothelial carcinoma (UC), yet recurrence remains common. We investigated the prognostic impact of clinical and systemic inflammatory factors in these patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 127 patients who received adjuvant nivolumab following radical surgery at six institutions between April 2022 and January 2026. Prognostic factors for DFS were evaluated using Cox proportional hazards regression models.</p><p><strong>Results: </strong>The median follow-up was 12.0 months, and DFS events occurred in 43.3% of patients. In the multivariable analysis, advanced pathological T stage (pT3-4 vs. pT1-2) (HR [hazard ratio], 2.525; 95% CI [confidence interval], 1.067-5.979) and baseline neutrophil-to-lymphocyte ratio (NLR) (HR, 1.216 per 1 unit increase; 95% CI, 1.034-1.430; p = 0.018) emerged as independent predictors of inferior DFS. Additionally, female sex showed an independent association with shorter DFS (HR, 0.275; 95% CI, 0.152-0.495; p < 0.001, though this finding warrants cautious interpretation given baseline characteristics and the small proportion of female patients.</p><p><strong>Conclusions: </strong>Baseline NLR and advanced pT stage serve as valuable independent prognostic factors for patients receiving adjuvant nivolumab. Although interpreted with caution regarding specific subgroups and retrospective limitations, these findings highlight key risk factors in this setting and provide a rationale for larger prospective validation.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes after buccal mucosa graft urethroplasty: a single-center cohort with 7-year median follow-up and systematic review of the literature.","authors":"Juliane Putz, Georgi Tosev, Valentin Kluge, Christer Groeben, Steffen Leike, Sven Oehlschläger, Roman Herout, Manfred P Wirth, Christian Thomas, Martin Baunacke, Johannes Huber","doi":"10.1159/uin/aewag024","DOIUrl":"https://doi.org/10.1159/uin/aewag024","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Buccal mucosa graft urethroplasty (BMGU) is the standard therapy for recurrent and complex urethral strictures. Data on outcomes beyond 5 years are scarce. This study analyzes long-term results after BMGU and compares them systematically with published cohorts.</p><p><strong>Material and methods: </strong>Patients who underwent BMGU between 1996 and 2015 were identified. Exclusion criteria included female sex and prior hypospadias repair. Details of patient selection are reported in the Results section. A systematic review of the literature was conducted in accordance with the PRISMA statement.</p><p><strong>Results: </strong>The response rate was 49% (115/237). Median age at surgery was 62 years. Patients had a median of 2 prior operations. Most commonly, internal urethrotomy (92%), dilatation (30%), and open reconstruction (11%) were performed. Median stricture length was 4.5 cm. Recurrence rate was 20% after a median follow-up of 7 years. Median time to recurrence was 70 months. In our cohort, longer operation duration and stricture localization, particularly bulbar and combined bulbar+penile strictures, were identified as risk factors for recurrence (p=0.002 and p=0.016, respectively). Across 14 studies (median follow-up 5-14.3 years, 7-733 patients), the pooled recurrence rate was 16.2% (362/2241), with stricture length, localization, prior surgery, lichen sclerosus, radiation, and infection as the most frequently reported risk factors.</p><p><strong>Conclusion: </strong>In our cohort with 20% recurrence rate after 7 years and across 14 long-term series with a pooled recurrence rate of 16.2%, BMGU consistently achieves durable long-term patency and should be preferred over repeated endoscopic procedures for recurrent or complex urethral stricture disease.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Gentamicin Prophylaxis in Robot-Assisted Prostatectomy: Are Surgical Confounders Adequately Addressed?","authors":"Ahmet Murat Bayraktar, Bilgi İşler","doi":"10.1159/uin/aewag004","DOIUrl":"10.1159/uin/aewag004","url":null,"abstract":"","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Laser Efficacy and Clinical Outcomes of Pulsed Thulium:YAG versus Standard Holmium:YAG Lithotripsy.","authors":"Yusuke Shirasu, Takashi Yoshida, Yutaro Oku, Shogo Murakami, Gen Kawa","doi":"10.1159/uin/aewag005","DOIUrl":"10.1159/uin/aewag005","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to compare the efficacy and clinical outcomes of ureteroscopic lithotripsy using the holmium:YAG laser (Ho:YAG) and pulsed thulium:YAG laser (p-Tm:YAG: RevoLix HTL, LISA Laser Products, Germany) for upper urinary tract stones.</p><p><strong>Methods: </strong>This retrospective single-center study included patients who underwent ureteroscopy for kidney or ureteral stones between August 2023 and August 2025. Patients with bilateral stones, concomitant procedures, stones ≥20 mm, or without preoperative computed tomography imaging were excluded. Endpoints included operative time, laser efficacy (ratio of cumulative stone volume to operative time), and the stone-free rate (SFR).</p><p><strong>Results: </strong>We analyzed 104 patients (Ho:YAG, n = 54; p-Tm:YAG, n = 50). The p-Tm:YAG group exhibited significantly shorter operative time (46.0 vs. 66.5 min, p < 0.001) and higher laser efficacy (0.237 vs. 0.175 mm3/min, p = 0.016). Subgroup analysis revealed that p-Tm:YAG exhibited significantly shorter operative times (49.0 vs. 96.0 min, p < 0.001) and superior laser efficacy (0.252 vs. 0.183 mm3/min, p = 0.008) for stones measuring 10-20 mm, whereas similar outcomes were observed for stones <10 mm between the two groups. The Ho:YAG and p-Tm:YAG groups exhibited similar SFRs on postoperative day 1 (79.6% vs. 88.0%, p = 0.182) and at 1 month (87.0% vs. 92.0%, p = 0.325).</p><p><strong>Conclusion: </strong>Both lasers achieved comparable and high SFRs for stones <20 mm. However, the p-Tm:YAG laser offers higher laser efficacy and significantly shorter operative times, particularly for larger stones (10-20 mm), supporting its use as an efficient alternative to the Ho:YAG laser.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary pH and Checkpoint Inhibitor Outcomes in Advanced Urothelial Carcinoma: An Exploratory Brief Report.","authors":"Satoshi Yamamoto, Manabu Kanasugi, Tomoki Shirafuji, Hiroki Bamba, Sanji Kanaoka, Kazuyoshi Nakamura","doi":"10.1159/uin/aewag031","DOIUrl":"10.1159/uin/aewag031","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary pH is a low-cost host-related marker, but its association with immune checkpoint inhibitor outcomes in advanced urothelial carcinoma is uncertain.</p><p><strong>Methods: </strong>We retrospectively reviewed 45 consecutive patients with advanced urothelial carcinoma who received pembrolizumab or avelumab and had urinary pH measured at treatment initiation. Baseline urinary pH was categorized as ≥6.5 or <6.5. Outcomes were objective response rate (ORR), progression-free survival (PFS), and overall survival. Cox models were adjusted for Bellmunt risk score. Early urinary pH dynamics were examined when available.</p><p><strong>Results: </strong>Baseline urinary pH was ≥6.5 in 20 patients and <6.5 in 25. Objective response rate was 40.0% versus 16.0%, respectively. Baseline urinary pH ≥6.5 was associated with longer PFS after Bellmunt adjustment (hazard ratio, 0.39; 95% CI, 0.17-0.86), whereas the association with overall survival was weaker. Among 32 patients with early urinary pH data, ORR was 41.7% in the high-high group, 28.6% in the low-high group, and 0% in the low-low group. In a pembrolizumab-only sensitivity cohort, the direction of association with real-world PFS was preserved but attenuated.</p><p><strong>Conclusion: </strong>Urinary pH showed an exploratory association with checkpoint inhibitor outcomes. Because urinary pH is influenced by renal function, infection, medication, hydration, and diet, it should be interpreted as a hypothesis-generating host-related signal rather than a direct surrogate of tumor acidity.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}