World Journal of Urology最新文献

{"title":"The role of phosphatidylinositol (18:1_18:1) in benign prostatic hyperplasia: an integrated study of Mendelian randomization and network pharmacology.","authors":"Bingliang Chen, Zhen He, Shirong Peng, Bingheng Li, Yuan Ou, Ruilin Zhuang, Ruihui Xie, Hai Huang","doi":"10.1007/s00345-025-05870-4","DOIUrl":"https://doi.org/10.1007/s00345-025-05870-4","url":null,"abstract":"<p><strong>Background: </strong>Benign Prostatic Hyperplasia (BPH), marked by prostate enlargement, can greatly reduce quality of life. While studies hint at a connection between lipids and BPH, the roles of different lipid types are not well understood. The exact impact and treatment potential of these lipids in BPH are unclear, necessitating more research. Mendelian randomization (MR) provides a rigorous framework for elucidating causal relationships between modifiable exposures and outcomes, by leveraging the random assortment of genetic variants during gametogenesis. The aim of the current study was to systematically explore the underlying causal role of plasma lipids in the risk of BPH via two-sample MR analysis to find novel target for the treatment of BPH.</p><p><strong>Methods: </strong>Using two-sample MR analyses with data from the FinnGene and UK Biobank cohorts, we comprehensively investigated the causal effects of 179 circulating lipids on benign prostatic hyperplasia (BPH) risk. Integrated network pharmacology explored lipids-BPH interactions. lipids target predicted via multi-database screening (SuperPred/TargetNet/PharmMapper/SwissTargetPrediction) with UniProt validation. BPH targets sourced from DisGeNET/GeneCards/TTD/OMIM. Molecular docking performed in Discovery Studio. Shared targets analyzed through PPI networks. Hub genes identified by CytoHubba using four topological algorithms. GO/KEGG enrichment were considered significant with P ≤ 0.05.</p><p><strong>Findings: </strong>Genetically proxied circulating Phosphatidylinositol (18:1_18:1) (Pl(18:1_18:1)) and Phosphatidylcholine (16:0_18:2) (PC(16:0_18:2)) demonstrated significant inverse associations with BPH risk. In FinnGen Biobank, Pl(18:1_18:1) yielded OR = 0.95 (95%CI 0.90-0.99, P = 2.98 × 10⁻³) by IVW, OR = 0.91 (0.86-0.98, P = 7.24 × 10⁻³) by WM, and OR = 0.93 (0.82-1.05, P = 0.25) by MR-Egger; PC(16:0_18:2) showed OR = 0.95 (0.91-0.99, P = 2.43 × 10⁻²), OR = 0.95 (0.90-1.00, P = 4.09 × 10⁻²), OR = 0.93 (0.84-1.02, P = 0.13). In UK Biobank, Pl(18:1_18:1) exhibited OR = 0.88 (0.81-0.95, P = 1.25 × 10⁻²), OR = 0.88 (0.78-0.98, P = 2.26 × 10⁻²), OR = 0.80 (0.67-0.95, P = 2.29 × 10⁻²); PC(16:0_18:2) demonstrated OR = 0.92 (0.86-0.98, P = 9.90 × 10⁻⁴), OR = 0.93 (0.85-1.02, P = 0.10), OR = 0.89 (0.70-1.01, P = 7.98 × 10⁻²). Sensitivity analyses across both the FinnGen and UK Biobank cohorts confirmed robust causal estimates for the identified lipid-BPH relationships. No evidence of disproportionate SNP influence was detected(FinnGene: PC(16:0_18:2) P = 0.024, Pl(18:1_18:1) P = 0.021; UK Biobank: PC(16:0_18:2) P = 0.032, Pl(18:1_18:1) P = 0.041). Advanced MR analyses, supplemented by network pharmacology approaches, suggest that Pl(18:1_18:1) may reduce the risk of BPH by modulating the activity of the epidermal growth factor receptor (EGFR) rather than by altering its expression levels(OR = 1.02 95%CI, 0.93-1.12, P = 0.65 by IVW; OR = 1.07, 95%CI 0.95-1.21, P = 0.28 by WM; ","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"569"},"PeriodicalIF":2.9,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse events during radical prostatectomy and their association with recurrence and death.","authors":"Sofia Erestam, Ying Li, Eva Angenete, Anders Bjartell, Carolina Ehrencrona, Jonas Hugosson, Anna Lantz, Peter Wiklund, Eva Haglind","doi":"10.1007/s00345-025-05932-7","DOIUrl":"10.1007/s00345-025-05932-7","url":null,"abstract":"<p><strong>Objectives: </strong>The objective was to explore if adverse events during radical prostatectomy for prostate cancer were associated with oncological outcomes. A further objective was to identify risk factors for adverse events.</p><p><strong>Methods: </strong>A post-hoc study nested in a prospective, controlled trial of radical prostatectomy by robot assisted laparoscopic or open retropubic approach in Sweden. Adverse events during surgery were collected from clinical record forms (CRFs) filled out by the surgeon at operation. Recurrence was identified from CRFs and patient reports, cause of death through the Swedish National Cause of Death Register. Recurrence was defined as undetectable PSA 6-12 weeks after prostatectomy followed by PSA > 0.25 ng/ml or treatment for prostate cancer recurrence. Cox regression was used to explore associations between exposure and outcome.</p><p><strong>Results: </strong>One/more adverse events occurred during 39% (1356/ 3444) of operations. Adverse events were associated with recurrence, but not with all-cause or prostate cancer specific mortality. Intraoperative extensive bleeding and difficulties during dissection were associated with recurrence. Risk factors included age at surgery, history of TUR-P or abdominal surgery, teaching, prostate weight and lymph node dissection. Limitations included the low number of observations (deaths), particularly in subgroup analyses and hospital volume. This study should be regarded as explorative. In this explorative study adverse events during radical prostatectomy were associated with increased risk for recurrence.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"570"},"PeriodicalIF":2.9,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fumarate hydratase-deficient renal cell carcinoma: high intratumoral and peritumoral CD4-positive T cell infiltration density and high PD-L1 expression.","authors":"Yanfei Yu, Qi Shen, Mancheng Xia, Cong Huang, Xuesong Li, Shiming He, Aixiang Wang, Suxia Wang","doi":"10.1007/s00345-025-05941-6","DOIUrl":"https://doi.org/10.1007/s00345-025-05941-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fumarate hydratase (FH)-deficient renal cell carcinoma (RCC) represents a rare and aggressive subtype of RCC, closely associated with hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC). The limited understanding of this disease presents significant clinical challenges in its management. To date, robust evidence supporting the efficacy of systemic therapies for FH-deficient RCC remains scarce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study is to assemble a relatively large single-center cohort of FH-deficient RCC, focusing on clinical, pathological, and immune cell infiltration characteristics, particularly CD4-positive (CD4⁺) and CD8-positive (CD8⁺) T-cell infiltrates. This aims to enhance our understanding of FH-deficient RCC and provide evidence-based support for optimizing its systemic treatment strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We have retrospectively reviewed clinicopathologic and genetic prognostic data of patients operated on for renal tumor between January 2013 and June 2023 at Peking University First Hospital. Additionally, we employed multiplex immunofluorescence to evaluate the expression profiles of T cells within the tumor-infiltrating microenvironment of these patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study analyzed 27 patients (median age: 39.3 years; range 16-70; M: F = 14:13) with 31 renal tumors, including two multifocal cases. Histopathological evaluation revealed 25 high-grade tumors (WHO/ISUP G3-4) and two low-grade tumors (one with focal high-grade features and one entirely low-grade). Immunohistochemistry demonstrated universal strong 2SC positivity in all cases, while GATA3 expression (7 cases) was largely focal. Genomic profiling of 23 patients identified 18 germline and 3 somatic FH mutations, with two cases lacking FH alterations; MSI-L was detected in two tumors (others MSS). Multiplex immunofluorescence of 19 FH-deficient renal cell carcinomas revealed elevated PD-L1 expression (63.16% tumor cells) and distinct immune infiltration patterns: CD4&lt;sup&gt;+&lt;/sup&gt; T cell density exceeded CD8&lt;sup&gt;+&lt;/sup&gt; cells overall (1,125 vs. 336/mm², P = 0.005), with higher T cell accumulation at tumor margins (CD4&lt;sup&gt;+&lt;/sup&gt;: 1,431/mm²; CD8&lt;sup&gt;+&lt;/sup&gt;: 332/mm²) versus centers (CD4&lt;sup&gt;+&lt;/sup&gt;: 911/mm²; CD8&lt;sup&gt;+&lt;/sup&gt;: 164/mm²; P&lt;sub&gt;CD4&lt;/sub&gt;=0.005, P&lt;sub&gt;CD8&lt;/sub&gt;=0.017). CD4&lt;sup&gt;+&lt;/sup&gt; dominance persisted across all regions, suggesting a unique immunophenotypic signature in FH-deficient tumors. In FH-deficient RCC, only PD-L1 expression significantly predicted survival: PD-L1-positive patients had prolonged OS (median NR vs. 29.73 months in PD-L1-negative; P = 0.03).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This analysis highlights the spatial heterogeneity of T-cell infiltration in FH-deficient RCCs and suggests a potential role for PD-L1-targeted therapies in this subset of tumors. These findings suggest a distinct spatial distribution of immune cell subsets wit","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"567"},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Percutaneous Nephrolithotomy in Kidney Transplant Recipients: Results from a Multicenter Study by the Spanish Urology Association's Renal Transplant Group.","authors":"A Sierra, H Alfambra, J M López, A Mercadé, L L Peri, R Espílez, M Álvarez-Maestro, R Martínez-Corral, D A Pérez-Fentes, B Etcheverry, S Colom, F Vigués, A Alcaraz, M P Luque, C Torrecilla, M Musquera","doi":"10.1007/s00345-025-05467-x","DOIUrl":"10.1007/s00345-025-05467-x","url":null,"abstract":"<p><strong>Introduction: </strong>Stone disease amongst kidney transplant recipients (KTR) may not only lead to significant morbidity but also compromise graft function. In this context, percutaneous nephrolithotomy (PCNL) has emerged as a fundamental minimally invasive surgical technique for the treatment of kidney stones in KTR. The aim of this study is to evaluate the outcomes of PCNL in KTR in a nationwide series, encompassing operative results, stone-free rate (SFR), stone composition and renal graft function.</p><p><strong>Materials & methods: </strong>Retrospective data from five Spanish tertiary hospitals was analysed. All KTR that underwent PCNL between January 2005 and August 2024 were included in the study. Stone characteristics, postoperative complications, and surgical outcomes were evaluated.</p><p><strong>Results: </strong>The study included 39 KTR, median age 59 (32-82) years, predominantly male (71.8%). Most KTR received grafts from cadaveric donors (n = 35). Even though stone diagnosis was often incidental (64.1%), 74.3% of KTR experienced stone-related events before surgery, such as acute kidney failure (53.8%) and sepsis (15.4%). Diagnosis occurred after a median of 53 (0-264) months post-transplant. Preoperative nephrostomy insertion was common (59.0%), and 48.7% of KTR had positive urine cultures. Median stone size was 14 (5-50) mm with 53.8% of KTR having multiple stones. Median stone density was 720 (130-1770) HU. Overall complication rate after PCNL was 10.2%: 2 patients presented with urinary septic shock, 1 patient experienced puncture site bleeding requiring embolization and 1 haematuria accompanied by acute renal failure. Stone-free rate was 82.0% in the first procedure, with secondary treatments being successful when needed. The most frequent stone composition was calcium oxalate monohydrate (55.2%).</p><p><strong>Conclusions: </strong>In our experience, PCNL is an effective and safe technique for addressing nephrolithiasis in KTR. SFR and complication rates may be comparable to those reported in PCNL performed in native kidneys. Furthermore, patients tend to benefit from surgical care in high-volume centres that possess dedicated expertise in both KT and endourology.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"564"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-based radiomics for predicting stone-free rate after ESWL: a systematic review and meta-analysis.","authors":"Ali Talyshinskii, Stanislav Ali, Vineet Gauhar, Selcuk Güven, Bhaskar Kumar Somani, Kemal Sarica, Nariman Gadzhiev","doi":"10.1007/s00345-025-05933-6","DOIUrl":"10.1007/s00345-025-05933-6","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the prognostic significance of computed tomography (CT)-based radiomic features of urinary stones in predicting stone-free rate (SFR) after extracorporeal shockwave lithotripsy (ESWL) and laser lithotripsy.</p><p><strong>Methods: </strong>A systematic literature search of several databases using Boolean operators was performed according to PRISMA guideline and registered in PROSPERO (CRD420250650566). Studies using CT-based radiomics to predict SFR after ESWL or laser lithotripsy and reporting area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CI) were included. CLAIM and PROBAST checklists were used to assess transparency and and and risk of bias, respectively. A random-effects meta-analysis was performed to pool AUC estimates and assess heterogeneity.</p><p><strong>Results: </strong>Seven studies were selected and analyzed, of which five described radiomic prediction for ESWL and were analyzed in the meta-analysis. The pooled AUC for radiomics-based models predicting SFR after ESWL was 0.883 (95% CI: 0.840-0.927), with low heterogeneity (I² = 24.3%) and a prediction interval of 0.77-0.96. All studies were rated at high risk of bias with moderate compliance.</p><p><strong>Conclusion: </strong>Adding CT-based radiomic features of stones to other clinical and radiologic parameters can predict SFR after ESWL with an AUC of > 0.85. However, the results are based on a small number of studies mostly with a high risk of bias, so follow-up studies performed according to the tenets of using radiomic analysis are needed.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"566"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Old versus new tools to reduce retropulsion of proximal ureteral stones: virtual basket versus Magneto technology pulse modulation, which is the most effective?","authors":"Davide Perri, Umberto Besana, Giovanni Balocchi, Giovannalberto Pini, Eugenio Ventimiglia, Javier Romero-Otero, Jean-Baptiste Roche, Dmitry Pushkar, Alexander Govorov, Antonio Luigi Pastore, Ioannis Kartalas Goumas, Laurian Dragos, Giorgio Bozzini","doi":"10.1007/s00345-025-05944-3","DOIUrl":"https://doi.org/10.1007/s00345-025-05944-3","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"565"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient urology consultations: intervention rates, determinant factors, and findings related to the refugee population.","authors":"Umit Uysal, Ergun Alma, Adem Altunkol, Hakan Anıl, Mert Hamza Özbilen, Serkan Tugrul, Cafer Akcor","doi":"10.1007/s00345-025-05946-1","DOIUrl":"https://doi.org/10.1007/s00345-025-05946-1","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of our study was to evaluate the frequency of intervention requirements in inpatient urology consultations and the clinical and demographic factors influencing these decisions.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed urology consultations over a one-year period at a large tertiary regional hospital. The timing and location of consultations, indications, procedures performed, and the need for intervention were evaluated. Univariate and multivariate logistic regression analyses were conducted to identify predictors of intervention.</p><p><strong>Results: </strong>A total of 1,977 consultations were identified. The most common reasons for consultation were hematuria (18.9%), male lower urinary tract symptoms (18.3%), and obstructive uropathy (14.3%). The majority of consultations originated from the emergency department (59.5%). Urologic interventions were performed in 52.5% of the patients, with the most frequent procedures being urethral catheterization (18.2%), bladder irrigation (7.9%), and suprapubic catheterization (3%). According to the univariate analysis, refugee patients had a significantly higher intervention rate (p = 0.046). In the multivariate analysis, factors independently associated with the need for intervention included consultations initiated from the emergency department, the level of seniority of the evaluating physician, and symptom-based consultation requests (p < 0.001).</p><p><strong>Conclusion: </strong>Inpatient urology consultations constitute a significant clinical workload, and a considerable proportion of those requiring intervention involve simple procedures that can be performed by nonurologist healthcare personnel. The high rate of noninterventional consultations reduces service efficiency. Improving triage systems and providing targeted training to healthcare staff may help alleviate this burden.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"563"},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a predictive nomogram for treatment response to urethral botulinum toxin A injection in women with non-neurogenic dysfunctional voiding.","authors":"Yu-Chen Chen, Jing-Hui Tian, Hann-Chorng Kuo","doi":"10.1007/s00345-025-05888-8","DOIUrl":"https://doi.org/10.1007/s00345-025-05888-8","url":null,"abstract":"<p><strong>Purpose: </strong>To identify predictors of treatment success after urethral botulinum toxin A (100 U) injection in women with video-urodynamic study (VUDS)-diagnosed non-neurogenic dysfunctional voiding (DV), and to develop a nomogram for individualized clinical prediction.</p><p><strong>Methods: </strong>We retrospectively reviewed 398 women with VUDS-confirmed non-neurogenic DV treated with urethral botulinum toxin A at a tertiary center. Baseline demographics and urodynamic variables were compared between responders (Global Response Assessment [GRA] ≥ 2 at 3 months) and non-responders (GRA < 2). Predictive modeling used multivariate logistic regression with stepwise selection. The entire cohort was randomly split into a training set (70%) for model development and a test set (30%) for internal validation. Model discrimination was evaluated by area under the receiver operating characteristic curve (AUC), and a nomogram was constructed from independent predictors.</p><p><strong>Results: </strong>At 3-month follow-up, 186 patients (46.7%) were classified as responders. Responders had significantly fewer prior Botox injections, lower bladder sensation thresholds, higher detrusor pressure at Qmax (Pdet), higher maximum flow rate (Qmax), greater voided volume, lower cystometric bladder capacity, higher voiding efficiency, and lower post-void residual (PVR). Multivariate analysis identified older age (OR: 1.025), higher Pdet (OR: 1.029), and lower PVR (OR: 0.989) as independent predictors of success. The model showed excellent discrimination in training (AUC = 0.847) and test (AUC = 0.871) sets. A nomogram was developed for individualized risk estimation.</p><p><strong>Conclusion: </strong>Older age, higher Pdet, and lower PVR independently predict successful response to urethral botulinum toxin A in women with non-neurogenic DV. This nomogram may guide personalized counseling and treatment decisions.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"562"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid in radical cystectomy: a systematic review and meta-analysis of efficacy and safety.","authors":"Maurin Helen Mangold, Victoria Luise Simone Wieland, Maurizio Grilli, Alexander Studier-Fischer, Caelán Max Haney-Aubert, Niklas Westhoff, Maurice Stephan Michel, Luisa Egen, Karl-Friedrich Kowalewski","doi":"10.1007/s00345-025-05939-0","DOIUrl":"10.1007/s00345-025-05939-0","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"560"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency nephrectomy in surgical pyelonephritis: outcomes and predictors of conservative management failure.","authors":"Romain Lefranc, Thibaut Waeckel, Arnaud Doerfler, Xavier Tillou","doi":"10.1007/s00345-025-05900-1","DOIUrl":"https://doi.org/10.1007/s00345-025-05900-1","url":null,"abstract":"<p><strong>Background: </strong>Surgical pyelonephritis (SP) encompasses severe upper urinary tract infections, including pyonephrosis, renal and perinephric abscesses, and emphysematous pyelonephritis. The 2024 EAU Guidelines classify these as complicated UTIs requiring early antibiotic therapy, hemodynamic stabilization, and prompt source control. This study aimed to reassess the role of emergency nephrectomy (EN) in SP management and to identify predictors of conservative management (CM) failure.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study including patients treated for SP at Caen University Hospital, France, between January 2011 and December 2022.</p><p><strong>Results: </strong>Eighty-eight patients were included: 10 underwent primary EN, and 78 received CM, of whom 9 (11.5%) later required secondary nephrectomy (SN) due to CM failure. Renal abscesses (RA) were the most frequent indication for EN, followed by emphysematous pyelonephritis. Diabetes was significantly more prevalent in EN patients (p < 0.001). Urinary tract obstruction was observed in 30.0% of EN patients versus 82.1% of those initially treated conservatively (p = 0.001). Initial EN patients had higher severe morbidity rates than CM patients (50.0% vs. 29.5%, p = 0.04), although similar to SN patients (66.7% vs. 50.0%, p = 0.07). A high ASA score, chronic kidney disease (CKD), and smoking were associated with an increased risk of CM failure.</p><p><strong>Conclusions: </strong>Surgical pyelonephritis should be managed stepwise, favoring conservative approaches when possible. Early identification of patients at risk of failure is crucial, and timely escalation to nephrectomy may improve outcomes. Biomarkers and standardized reassessment protocols may support better risk stratification.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"561"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}