World Journal of Urology最新文献

{"title":"Pressure-flow behavior during RIRS irrigation: a controlled ex vivo porcine kidney study of flow-dependent apparent outflow resistance.","authors":"Baorong Feng, Yan Yang, Shoule Wang, Xiaoming Li, Ziteng Shen, Haoyuan Liu, Wen Zhong","doi":"10.1007/s00345-026-06817-z","DOIUrl":"10.1007/s00345-026-06817-z","url":null,"abstract":"<p><strong>Purpose: </strong>To measure actual irrigation flow and intrarenal pressure (IRP) under different irrigation modes during retrograde intrarenal surgery (RIRS), and to develop a controlled ex vivo empirical pressure-flow model for the tested endoscope-sheath configurations.</p><p><strong>Methods: </strong>A controlled ex vivo porcine kidney-ureter model was used, with all measurements taken using a 200 μm holmium laser fiber in the working channel of a 7.5Fr or 6.3Fr flexible ureteroscope and 10/12Fr or 12/14Fr suction access sheaths. Manual syringe, gravity, and automatic pump irrigation were tested across three porcine kidney-ureter units. Each condition was measured in triplicate (technical repeats); condition-level means were used for model fitting and internal assessment.</p><p><strong>Results: </strong>Actual flow rose with driving pressure and fell with scope deflection. For the ZSR pump, flow increased from 32.0 to 99.8 mL/min (7.5Fr) and from 9.3 to 49.7 mL/min (6.3Fr) across the tested pressures. Pooling pump and syringe data, apparent outflow resistance increased at higher flow, so the non-suction relation was described by [Formula: see text]. Across 20 condition-level means, the complete model gave an RMSE of 1.04 mmHg and R² of 0.994. In a single-operator full-speed syringe test, back-calculated driving pressure was approximately 600 to 770 mmHg.</p><p><strong>Conclusion: </strong>In this controlled ex vivo model, apparent outflow resistance was flow-dependent, and the empirical model described the tested pressure-flow behavior. Forceful syringe flushing should not be routine when controlled pump, water-injection, or adequate gravity irrigation is available. Clinical safety claims require in vivo and clinical validation.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138209","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":"Risk factors and machine learning-based prediction of difficult ureter during retrograde ureteroscopic lithotripsy.","authors":"Safa Akyol, Doğan Sabri Tok, Ercan Öğreden, Erhan Demirelli, Ertürk Altun, Eren Baş, Erol Eğrioğlu, Ural Oğuz","doi":"10.1007/s00345-026-06793-4","DOIUrl":"10.1007/s00345-026-06793-4","url":null,"abstract":"<p><strong>Objective: </strong>Difficult ureter (DU) is a challenging condition that prevents successful access to the upper urinary tract during retrograde ureteroscopic lithotripsy (URS). The present study aimed to identify clinical risk factors for DU and to evaluate the predictive performance of machine learning-based models in patients undergoing URS for ureteral stones.</p><p><strong>Methods: </strong>Medical records of patients who underwent retrograde ureteroscopic lithotripsy between January 2023 and January 2024 were retrospectively reviewed. A total of 221 patients were included and classified into difficult ureter (DU) and non-difficult ureter (NDU) groups. Demographic characteristics, comorbidities, laboratory parameters, and perioperative findings were compared. Conventional statistical analyses were performed using univariate and multivariate regression models. In addition, supervised machine learning algorithms, including decision tree, logistic regression, naive Bayes, support vector machine, k-nearest neighbors, bagged trees, and multilayer perceptron artificial neural network (ANN), were developed to predict DU. Model performance was assessed using 3-fold cross-validation.</p><p><strong>Results: </strong>Difficult ureter was identified in 34 patients (15.4%). Absence of hydronephrosis, lack of medical expulsive therapy, elevated C-reactive protein (CRP > 5 mg/L), and gout were significantly associated with DU. Multivariate logistic regression analysis identified elevated CRP levels and diabetes mellitus as independent predictors. Among the machine learning models, the multilayer perceptron ANN demonstrated the best performance, with an accuracy of 86.9% and an area under the receiver operating characteristic curve of 0.816. Feature importance analysis revealed CRP as the most influential predictor, consistent with conventional statistical findings.</p><p><strong>Conclusion: </strong>Elevated CRP levels, gout, absence of hydronephrosis, and lack of medical expulsive therapy are important risk factors for difficult ureter during ureteroscopic lithotripsy. Machine learning-based models, particularly artificial neural networks, may provide additional predictive value and serve as decision-support tools for preoperative risk stratification in clinical practice.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115613","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":"Patient awareness and perceptions of a kidney stone multidisciplinary team (MDT): a questionnaire survey.","authors":"John Bose, Amelia Pietropaolo, Sohani N Dassanayake, Bhaskar Kumar Somani","doi":"10.1007/s00345-026-06842-y","DOIUrl":"10.1007/s00345-026-06842-y","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney stone disease (KSD) is a common condition associated with high recurrence rates and significant healthcare costs. Multidisciplinary team (MDT) working has become central to the management of many complex conditions; however, its use in KSD remains inconsistent. This questionnaire survey aimed to evaluate patient awareness, understanding, and perceptions of the kidney stone MDT, while identifying opportunities to improve communication and patient engagement.</p><p><strong>Methods: </strong>A single-centre questionnaire survey was conducted among patients attending the Southampton General Hospital Urology Department (Southampton, UK) between September and December 2025. Patients with and without a history of KSD were invited to complete an anonymous online questionnaire distributed via QR code. The survey included 17 items consisting of multiple-choice, Likert-scale, and open-ended questions assessing awareness of MDT working, perceived benefits, communication preferences, and areas for improvement. Descriptive statistics and chi-squared testing were used for analysis.</p><p><strong>Results: </strong>A total of 151 responses were collected, including 51 (33.8%) patients with KSD and 100 (66.2%) without KSD. Most respondents believed that MDT working improved both the quality and efficiency of care, and approximately 84% stated that they would want their case discussed within an MDT. Baseline awareness of the MDT system was low, however 92% self-reported improved understanding immediately after participation in the questionnaire. Patients expressed a preference for greater involvement in MDT decision-making, with mean involvement scores of 6.63 and 6.78 among KSD and non-KSD participants, respectively. Email was the most commonly selected communication method within this digitally recruited cohort. No statistically significant differences were detected between groups, but the study was not powered to establish equivalence.</p><p><strong>Conclusion: </strong>Among respondents, attitudes toward the kidney stone MDT were generally positive, although these findings should be interpreted in the context of a self-selected, single-centre sample. Baseline understanding of MDT working was limited, highlighting opportunities to improve patient information and communication. Future work should use validated tools, broader multicentre recruitment and objective clinical and patient-reported outcomes to evaluate MDT-based care.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115802","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":"Association of molecular subtypes based on GATA3, KRT5, and P16 expression with clinicopathological features and prognosis in upper tract urothelial carcinoma.","authors":"Jiayu Yang, Wentao Yu, Shengwang Zhang, Qian Chen","doi":"10.1007/s00345-026-06854-8","DOIUrl":"10.1007/s00345-026-06854-8","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to classify upper tract urothelial carcinoma (UTUC) using GATA3, KRT5, and P16 immunohistochemistry and to evaluate associations of these molecular subtypes with clinicopathological features and outcomes.</p><p><strong>Patients/materials and methods: </strong>Tissue samples from 102 UTUC patients who underwent radical nephroureterectomy were analyzed. Tumors were classified into genomically unstable (GU), urothelial-like (URO), and basal subtypes based on GATA3, KRT5, and P16 expression. Associations with pathological features, recurrence, and survival were analyzed. Kaplan-Meier and Cox regression analyses were used.</p><p><strong>Results: </strong>The GU, URO, and basal subtypes accounted for 33%, 45%, and 22% of cases, respectively. Subtype was significantly associated with infiltrative pattern (p = 0.009), perineural invasion (p = 0.016), histological variant (p < 0.001), T stage (p = 0.004), N stage (p = 0.017), and vital status (p = 0.005). The basal subtype showed the poorest prognosis, with 3-year overall survival of 41% vs. 85% for the URO subtype (p < 0.001). Multivariable analysis identified diffuse infiltrative pattern (HR 6.84, P = 0.004), lymphovascular invasion (HR 2.12, p = 0.046), and T4 stage (HR 9.80, p = 0.023) as independent risk factors for overall survival, and diffuse infiltrative pattern (HR 6.37, p = 0.006) and T4 stage (HR 12.6, p = 0.012) for recurrence-free survival.</p><p><strong>Conclusions: </strong>IHC-based subtyping using GATA3, KRT5, and P16 is significantly associated with aggressive clinicopathological features in UTUC, with the basal subtype showing poor prognosis in univariate analysis. However, it was not an independent prognostic factor in multivariable analysis. While this exploratory strategy may aid in risk stratification, its clinical utility requires further validation in larger, prospective cohorts.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115798","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":"Comparator purity and study-set composition in the comparison of ThuFLEP with conventional HoLEP.","authors":"Ting Ye","doi":"10.1007/s00345-026-06827-x","DOIUrl":"10.1007/s00345-026-06827-x","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115809","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":"Female stress urinary incontinence surgical trends in New Zealand from 2010 to 2025: before and after a mesh pause and national surgeon credentialing.","authors":"Eva Fong, Michael Keane, Sum Sum Lo, Giovanni Losco, Hazel Ecclestone","doi":"10.1007/s00345-026-06812-4","DOIUrl":"10.1007/s00345-026-06812-4","url":null,"abstract":"<p><strong>Objectives: </strong>To examine trends in surgical management of female stress urinary incontinence (SUI) from 2010 to 2025 including the impact of the mesh pause of August 2023 and national credentialing of surgeons.</p><p><strong>Methods: </strong>This retrospective cohort study used the Health New Zealand National Minimum Dataset (hospital events, NMDS). This includes all publicly funded hospital events from 2010-2025 for female stress urinary incontinence procedures being: mesh slings, fascial slings, Colposuspension and periurethral bulking agents.</p><p><strong>Results: </strong>There was significant and sustained decline in female SUI procedures beginning in 2013 to 2022. There was also a shift in procedural types with mesh slings being the predominant procedure before 2020 and periurethral bulking agents increasing from 2017. Following the mesh pause, there was no change in overall SUI activity prior to and after the pause. However, there was shift in the predominant procedures from mesh slings to periurethral bulking agents. In younger age groups the fall in sling procedures and increase in bulking was more marked. In the context of surgeon credentialing which began in 2022 through till october 2025, we found 64% of Colposuspensions and 22% of fascial slings were performed at a hospital without a New Zealand framework credentialled surgeon. Due to NMDS database being hospital/procedural based, we assigned credentialing at hospital level which may overestimate the availability of credentialled expertise at the hospital level.</p><p><strong>Conclusion: </strong>Between 2010 to 2025, there has been a sustained decline in female SUI procedures in New Zealand public hospitals. This decline began in 2013, nine years before the mesh pause of 2023. There has been a significant shift in the predominant SUI procedures following the mesh pause from highly efficacious procedures, mesh slings, to periurethral bulking agents, which are less efficacious. We also found that following credentialing, a significant proportion of procedures were performed in hospitals without a credentialed surgeon.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115725","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":"Re: Cormio A, Gauhar V, Herrmann T, et al. Influence of intraoperative tranexamic acid on bleeding outcomes in patients receiving antithrombotic therapy undergoing endoscopic enucleation of the prostate: a multicenter prospective study by the endourology section of EAU. World J Urol. 2026;44:179.","authors":"Edoardo Pozzi, Vincenzo Scattoni, Andrea Salonia, Alberto Briganti, Francesco Montorsi","doi":"10.1007/s00345-026-06823-1","DOIUrl":"10.1007/s00345-026-06823-1","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114889","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":"Reply to correspondence on perioperative monitoring during thulium laser prostate enucleation.","authors":"Philipp Kuhn, Thomas Wieser, JoEllen Welter, Roman Rechner, Jan T Klein, Thomas R W Herrmann, Alexander Dullenkopf","doi":"10.1007/s00345-026-06838-8","DOIUrl":"10.1007/s00345-026-06838-8","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115272","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":"The effect of ureteral stenting on the risk of metachronous upper tract urothelial carcinoma in patients with bladder tumors involving the ureteral orifice.","authors":"Nikolaos Pyrgidis, Patrick Engelmann, Daniel Puhr-Westerheide, Benedikt Ebner, Marc Kidess, Marie Semmler, Patrick Keller, Christian Stief, Gerald Bastian Schulz, Yannic Volz","doi":"10.1007/s00345-026-06839-7","DOIUrl":"10.1007/s00345-026-06839-7","url":null,"abstract":"<p><strong>Background: </strong>Ureteral stenting in patients with bladder cancer involving the ureteral orifice may increase the rate of metachronous upper tract urothelial carcinoma (UTUC). Nevertheless, evidence on the matter is scarce and often contradictory.</p><p><strong>Materials and methods: </strong>We performed an observational study comparing ureteral stenting versus no stenting with respect to the risk of developing metachronous UTUC in patients who underwent transurethral resection of bladder tumors (TURBT) involving the ureteral orifice between January 2015 and December 2024. We performed time-to-event analyses to estimate hazard ratios (HRs) along with their corresponding 95% confidence intervals (CIs).</p><p><strong>Results: </strong>We included 151 patients with a median age of 73 years. 37 (25%) underwent ureteral stenting during TURBT. Patients undergoing stenting had higher BMI (p = 0.014), more aggressive tumors (p = 0.003), underwent prior intravesical therapy more often (p = 0.008), higher preoperative creatinine values (p = 0.007), and longer hospitalization duration (p = 0.002) compared to those who did not undergo stenting. After a median follow-up of 25 months, 8 patients developed metachronous UTUC (2 in the stenting group and 6 in the non-stenting group). Ureteral stenting was not associated with statistically significantly higher rates of metachronous UTUC (HR: 1.2, 95%CI: 0.31-5.6, p > 0.9). During follow-up, 49 (33%) patients developed recurrence in the bladder, 43 (28%) underwent cystectomy, and 24 (16%) died. The HRs did not significantly differ between the two groups.</p><p><strong>Conclusions: </strong>The present study did not demonstrate an increased risk of metachronous UTUC after stenting during TURBT with urothelial cancer involving the ureteral orifice. Moreover, stenting was not statistically significantly associated with increased recurrences in the urinary bladder, higher cystectomy rates, or worse mortality.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115574","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":"Lymphocele After Radical Prostatectomy: A Systematic Review of Risk Factors and Quantitative Synthesis Preventive Strategies.","authors":"Ömer Faruk Çavdar, Burak Akgül, Furkan Güldibi, Bhaskar Somani, Karim Touijer, Alex de la Taille, Kamran Ahmed, Thomas Knoll, Thomas R W Herrman, Lütfi Tunç, Selçuk Güven","doi":"10.1007/s00345-026-06809-z","DOIUrl":"10.1007/s00345-026-06809-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to systematically evaluate the perioperative risk factors and preventive strategies associated with lymphocele formation and prolonged lymphatic drainage after radical prostatectomy with pelvic lymph node dissection, to assess the effect of peritoneal reconstruction techniques on symptomatic lymphocele reduction, and to provide an integrated clinical framework for evaluating etiological factors and preventive strategies.</p><p><strong>Materials and methods: </strong>A comprehensive search of Embase, MEDLINE (PubMed), and the Cochrane Library was performed through December 2025 according to PRISMA guidelines (PROSPERO ID: CRD420251164157). Thirty-one studies evaluating preoperative, intraoperative, and postoperative risk factors and preventive strategies were included. Risk of bias was assessed using RoB 2, ROBINS-I, and ROBINS-E tools. A primary meta-analysis of randomized controlled trials and a predefined sensitivity analysis including all comparative studies were conducted for symptomatic lymphocele (sLC) using random-effects models.</p><p><strong>Results: </strong>High BMI and selected metabolic parameters, including low fibrinogen and hypoalbuminemia, emerged as potential preoperative risk factors, although supporting evidence was limited and not consistently reported across studies. Peritoneal flap-based reconstruction significantly reduced symptomatic lymphocele in pooled randomized data (RR 0.57, 95% CI 0.35-0.95). A predefined sensitivity analysis including six comparative studies (n = 3840) suggested a larger effect (RR 0.18, 95% CI 0.09-0.37), although these findings should be interpreted cautiously because of potential confounding and heterogeneity across study designs and surveillance protocols. Preventive strategies such as peritoneal reconstruction and selective drain management were associated with reduced lymphatic complications, whereas octreotide and lymphatic embolization were effective management options for established or refractory lymphatic leakage.</p><p><strong>Conclusion: </strong>Lymphocele formation after radical prostatectomy is multifactorial. Restoration of peritoneal continuity appears to be the most consistent and modifiable strategy for reducing symptomatic lymphocele. These findings support a comprehensive, risk-adapted approach integrating patient- and procedure-related factors beyond isolated technical interventions and highlight the need for further multicenter randomized studies.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115800","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}