World Journal of Urology最新文献

{"title":"Separating mechanical dilation from paclitaxel-specific benefit in preclinical drug-coated balloon therapy for BPH.","authors":"Tiewu Tan, Xin Zhang, Hui Qin","doi":"10.1007/s00345-026-06828-w","DOIUrl":"10.1007/s00345-026-06828-w","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076011","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":"Aetiology of positive surgical margins in robotic assisted radical prostatectomy: a pathway approach.","authors":"Elizabeth Day, Andreia Bilé-Silva, Amit Bhudia, Abhishek Vigneshkumar, Georgi Petkov, Keiron Hakimnia, Farah Siddiqui, Aiman Haider, Louise Dickinson, Zafer Tandogdu","doi":"10.1007/s00345-026-06789-0","DOIUrl":"10.1007/s00345-026-06789-0","url":null,"abstract":"<p><strong>Purpose: </strong>Positive surgical margin (PSM) rates in robot-assisted radical prostatectomy (RARP) remain high and understanding their cause remains key to their elimination. We examined the prostate cancer pathway as a whole to systematically identify and quantify sourcescontributing to PSMs.</p><p><strong>Methods: </strong>Using a prospectively maintained database at a high-volume centre, we retrospectively analysed 100 consecutive patients with positive surgical margins (PSMs) following robot-assisted radical prostatectomy between January and December 2022. For each patient, a pre-operative imaging-based surgical plan was available. Potential sources contributing to PSMs were identified by reviewing diagnostic and staging information, the recommended surgical plan, the executed surgical template, and final pathology. Sources were categorised into three pathway phases: Diagnostic and Staging, Surgical Planning, and Surgical Execution. Proportions were reported with 95% confidence intervals calculated using the exact binomial (Clopper-Pearson) method.</p><p><strong>Results: </strong>A total of 112 positive surgical margins (PSMs) were identified in 100 patients. One hundred and twenty-five contributing sources were identified, with a single source attributed to 102 PSMs, two sources to 7 PSMs, and three sources to 3 PSMs. Surgical execution accounted for the majority of identified sources (98/125, 78.4%; 95% CI 70.2-85.3%), followed by surgical planning (14/125, 11.2%; 95% CI 6.3-18.1%) and diagnostic and staging factors (13/125, 10.4%; 95% CI 5.7-17.1%). Within the surgical execution category, nerve-sparing was the most frequently implicated surgical step, being associated with 57/112 PSMs (50.9%; 95% CI 41.3-60.5%), followed by apical dissection (34/112, 30.4%; 95% CI 22.0-39.8%).</p><p><strong>Conclusion: </strong>Despite high volume, the most common sourceis surgical execution. This represents an opportunity for intra-operative margin assessment to reduce PSM rates. Diagnostic and planning steps still contributed to one- fifth of PSMs and can also be improved. We emphasise how this novel systematic approach can be used as a framework in quality assurance and improvement processes.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075877","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":"Automating Clavien-Dindo classification with large language models in percutaneous nephrolithotomy: an exploratory study.","authors":"Gustavo Perrone, Alexandre Danilovic, Carlos Batagello, Fabio Cesar Miranda Torricelli, Fabio Carvalho Vicentini, Giovanni Scala Marchini, Rodrigo Perrella, William C Nahas, Eduardo Mazzucchi","doi":"10.1007/s00345-026-06833-z","DOIUrl":"10.1007/s00345-026-06833-z","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the use of large language models for Clavien-Dindo classification of complications following percutaneous nephrolithotomy by benchmarking their performance against physician grading.</p><p><strong>Methods: </strong>We evaluated ChatGPT, Copilot, DeepSeek, Gemini, Grok and Llama for defining Clavien-Dindo grades, classifying complications according to the Clavien-Dindo classification, and classifying case summaries with and without in-context prompting. Vignettes were obtained from a published consensus categorization of percutaneous nephrolithotomy complications. We measured agreement with Gwet's AC2 coefficient and compared it with attending urologists and urology residents.</p><p><strong>Results: </strong>All models accurately defined the Clavien-Dindo classification and graded with almost perfect agreement complication descriptions and case summaries (0.97 to 0.98 overall agreement). Six attendings and 15 residents classified the same vignettes, demonstrating lower agreement than the chatbots (0.95, p < 0.001 for residents; 0.96, p = 0.03 for attendings; 0.95, p < 0.001 for all participants). Models' latency ranged from 0.77 to 3.90 min, while the fastest physician required 17 min to complete the same tasks. Models' intrarater reliability was almost perfect: from 0.97 to 0.99. Interrater reliability between chatbots (0.97, 95% confidence interval: 0.97-0.98) was significantly higher than among physicians (0.93, 95% confidence interval: 0.92-0.94).</p><p><strong>Conclusion: </strong>Large language models show promise in being faster, more accurate, and precise than physicians in Clavien-Dindo classification in an experimental setting. We support the need for a prospective agreement study using real-world clinical records. We urge discussion of the legal and ethical implications.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075975","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":"Separating procedure burden from result burden after multimodal prostate biopsy.","authors":"Ting Ye","doi":"10.1007/s00345-026-06834-y","DOIUrl":"10.1007/s00345-026-06834-y","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076045","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":"Biopsy and identification of risk factors for discordance in renal tumor: results from the BIRD study (UroCCR n°230).","authors":"Stessy Kutchukian, G Margue, N Branger, P Bigot, A Fontenil, R Boissier, T Prudhomme, C Michel, V Chatain, T Waeckel, J B Beauval, C Champy, M Vallée, H Lang, S de Vergie, L Vignot, B Parier, F Taha, L Surlemont, J C Bernhard, F Audenet","doi":"10.1007/s00345-026-06832-0","DOIUrl":"10.1007/s00345-026-06832-0","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the rate of histological discordance between renal mass biopsy(RMB) and final surgical pathology in patients with localized renal tumors, and to identify risk factors of discordance.</p><p><strong>Materials and methods: </strong>The BIRD study is a retrospective multicenter analysis conducted within the prospective UroCCR database between February 2004 and January 2025. We included all patients who underwent a renal mass biopsy followed by surgical treatment(partial or radical nephrectomy). The primary endpoint was the histological discordance rate, defined as a mismatch in tumor type between the biopsy and the surgical specimen, or a non-diagnostic biopsy, and diagnostic accuracy. Univariate and multivariate logistic regression analyses were performed to identify factors associated with discordance.</p><p><strong>Results: </strong>A total of 1,301 patients from 19 centers were included, with 65% male and a median age of 63 years(51-71). Tumors were equally distributed between the right and left kidneys, with a median size of 3.7 cm(2.5-5.0). Final histology showed 8% benign and 92% malignant tumors. Tumor necrosis was found in 23% of cases. Among tumors assessed for nuclear grade, a 48% discordance was observed between low(ISUP1-2) and high grades(ISUP3-4). Overall, the histological discordance rate was 18%, including 3.7% for malignancy diagnosis, 8.4% for histological subtype, and 5.7% for non-diagnostic biopsies. On multivariable analysis after multiple imputation, cystic tumor(OR 2.18, 95%CI 1.23-3.85, p = 0.007) was independently associated with increased risk of histological discordance. Moderate and high R.E.N.A.L. score complexity were associated with reduced discordance risk(OR 0.67, 95%CI 0.47-0.96, p = 0.03 and OR 0.60, 95%CI 0.37-0.98, p = 0.04, respectively).</p><p><strong>Conclusions: </strong>RMB provided a high diagnostic yield but was associated with an overall 18% discordance rate. Cystic tumors were the only independent factor associated with an increased risk of discordance, while tumor complexity and size influenced discordance subtypes. Regarding ISUP grade, RMB showed imperfect reliability, failing to reflect true tumor aggressiveness in nearly half of discordant cases.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075982","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":"Vibegron, mirabegron, and other add-on therapies for persistent overactive bladder symptoms in α1-blocker-treated men with benign prostatic hyperplasia: a systematic review and Bayesian network meta-analysis.","authors":"Shugo Yajima, Gaku Okumura, Soichiro Yoshida, Hiroshi Fukushima, Takanobu Yamamoto, Hiroyuki Honda, Tomohiro Matsuo, Naoki Wada, Hiroyuki Sato, Akihiro Hirakawa, Hitoshi Masuda, Yasuhisa Fujii","doi":"10.1007/s00345-026-06820-4","DOIUrl":"10.1007/s00345-026-06820-4","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the efficacy and safety of vibegron, mirabegron, and other add-on therapies for overactive bladder (OAB)/storage symptoms persisting despite α1-blocker treatment in men with benign prostatic hyperplasia (BPH), focusing on the indirect vibegron-mirabegron comparison.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, CENTRAL, ClinicalTrials.gov, and Google Scholar through 27 August 2026. Bayesian random-effects network meta-analyses used mean differences for continuous outcomes and odds ratios (ORs) for study-reported treatment-period adverse events (AEs). Confidence was appraised with CINeMA.</p><p><strong>Results: </strong>Eighteen trials were included; 16 contributed quantitative data. Versus control, vibegron reduced micturitions per 24 h (mean difference - 0.81, 95% credible interval [CrI] - 1.31 to - 0.38) and urgency episodes per day (- 0.96, - 1.57 to - 0.34), and mirabegron reduced micturitions by 0.46 per 24 h (- 0.88 to - 0.02). For vibegron versus mirabegron, indirect estimates were - 0.35 micturitions per 24 h (- 1.05 to 0.26) and - 0.52 urgency episodes per day (- 1.33 to 0.35), with all 95% CrIs including the null value. Reported AE odds were also inconclusive versus mirabegron (OR 1.50, 0.69 to 3.14), and AE definitions varied. Confidence was moderate for vibegron versus control on micturitions and urgency and low for indirect and safety estimates.</p><p><strong>Conclusion: </strong>Vibegron reduced micturition frequency and urgency versus control and may be considered an add-on option in α1-blocker-treated men. The vibegron node rested on two trials, and no advantage over mirabegron was established; posterior probabilities above 0.8 do not indicate superiority when credible intervals include the null value.</p><p><strong>Registration: </strong>PROSPERO CRD420261434850.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076125","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":"Anatomical interpretation of membranous urethral length and posterior periurethral thickness after HoLEP: a commentary on Nagasaki et al.","authors":"Arif Huseynli, Ender Cem Bulut","doi":"10.1007/s00345-026-06822-2","DOIUrl":"10.1007/s00345-026-06822-2","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070207","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":"Beyond catheter-free rates: the need for procedure-stratified outcome reporting in preoperatively catheterized patients undergoing surgery for benign prostatic enlargement.","authors":"Xiaoyu Wang, Shanfang Yuan, Jianghua Yang, Xiaoxing Liao","doi":"10.1007/s00345-026-06826-y","DOIUrl":"10.1007/s00345-026-06826-y","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064934","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":"Slice thickness matters: CT-based evaluation of stone-free status with grade classification after RIRS.","authors":"Naoto Tanaka, Fukashi Yamamichi, Daiki Katsura, Satoshi Kitamura, Riku Mitsui, Kengo Sanada, Yosuke Fukiishi, Yasuhiro Kaku, Masaichiro Fujita, Satoshi Imai, Takaaki Inoue, Isao Hara","doi":"10.1007/s00345-026-06835-x","DOIUrl":"10.1007/s00345-026-06835-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the influence of computed tomography (CT) slice thickness on stone-free status (SFS) assessment following retrograde intrarenal surgery (RIRS).</p><p><strong>Methods: </strong>This retrospective single-center cohort study included 145 patients who underwent RIRS with MOSES technology between October 2022 and March 2023. Postoperative SFS was assessed using low-dose CT images reconstructed at 1-mm and 5-mm axial slice thicknesses. SFS was defined as follows: Grade A, no stones visible; Grade B, residual stone ≤ 2 mm; Grade C, residual stone 2.1-4 mm; and Grade D, residual stone > 4 mm. SFS grade distributions were compared using the McNemar-Bowker test. Residual stones were evaluated according to maximum stone diameter (MSD) and maximum attenuation value.</p><p><strong>Results: </strong>SFS grade distributions differed significantly between the two slice thicknesses (p < 0.001), with 5-mm images shifting patients toward more favorable SFS categories. Grade A increased from 42.8% (62/145) to 57.2% (83/145). Favorable SFS (Grades A-B) increased from 83.4% (121/145) to 93.8% (136/145), an absolute increase of 10.3% points (95% CI 5.4-15.3). Overall, 35 patients (24.1%; 95% CI 17.9-31.7%) were reclassified, with no reclassification to a worse grade. MSD and attenuation values were significantly lower on 5-mm images, indicating undermeasurement of residual stone size and attenuation values with thicker-slice reconstructions.</p><p><strong>Conclusion: </strong>CT reconstruction slice thickness significantly affected SFS assessment after RIRS. Thicker reconstructions may artifactually increase the apparent stone-free rate by underdetecting or undermeasuring small residual stones. When evaluating SFS with CT, the imaging protocol, including slice thickness, should be clearly reported.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070202","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":"Letter to the editor regarding \"Value of 3D-presumed circular area ratio in MRI assessment of benign prostatic hyperplasia\".","authors":"Ajay Guru","doi":"10.1007/s00345-026-06825-z","DOIUrl":"10.1007/s00345-026-06825-z","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064924","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}