World Journal of Urology最新文献

{"title":"Predicting postoperative pain in urology: psychological and social factors matter.","authors":"Dor Golomb, Fahed Atamna, Ido Bar, Hanan Goldberg, Yuval Avda, Orit Raz","doi":"10.1007/s00345-025-05827-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05827-7","url":null,"abstract":"<p><strong>Objective: </strong>To assess postoperative pain levels in patients undergoing urological surgeries and identify factors associated with increased pain.</p><p><strong>Patients and methods: </strong>This prospective single-center study (May 2022-December 2024) included 200 patients who completed the Hospital Anxiety and Depression Scale (HADS) questionnaire preoperatively. Postoperatively, the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was administered. Predictors of heightened postoperative pain were analyzed using multivariable logistic regression.</p><p><strong>Results: </strong>All 200 eligible patients participated. The median age was 55 years for males and 52 years for females, with males comprising 70% of participants. Most patients were married (67%) and had at least 12 years of education (89%). A history of anxiety or depression was reported in 16.5% of patients, while 65.5% had prior surgeries. The median preoperative HADS scores were 8 for males and 7 for females (p = 0.1), with abnormal anxiety in 40% of males and 30% of females. Increased HADS scores were significantly associated with higher postoperative pain (B = 0.165, 95% CI: 0.013-0.124, p = 0.016). Being unmarried was also linked to greater postoperative pain (B=-0.175, 95% CI: -1.215- (-0.091), p = 0.023). Other demographic and clinical factors, including age, gender, BMI, education, Charlson comorbidity score, and prior surgeries, were not significant predictors.</p><p><strong>Conclusions: </strong>Preoperative anxiety is a strong predictor of postoperative pain in urological surgeries, highlighting the need for targeted anxiety management. Marital status also plays a role, while other demographic and clinical variables show limited predictive value.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"442"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660403","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":"Which neurogenic bladder patients are at higher risk of sepsis after percutaneous nephrolithotomy?","authors":"Gustavo Perrone, Alexandre Danilovic, Lucas Dias, Giovanni Marchini, Fabio Torricelli, Carlos Batagello, Fabio Vicentini, Rodrigo Perrella, William C Nahas, Eduardo Mazzucchi","doi":"10.1007/s00345-025-05836-6","DOIUrl":"10.1007/s00345-025-05836-6","url":null,"abstract":"<p><strong>Purpose: </strong>To identify predictors of sepsis following percutaneous nephrolithotomy in patients with neurogenic bladder, without investigating causal pathways.</p><p><strong>Methods: </strong>We retrospectively analyzed a consecutive sample of patients with neurogenic bladder who underwent percutaneous nephrolithotomy at our referral center between 2009 and 2020. We also systematically searched PubMed until February 2025 for studies that investigated neurogenic patients undergoing this procedure. We then performed a single-arm meta-analysis of postoperative sepsis, including our own data, and meta-regressions to search for predictors.</p><p><strong>Results: </strong>In our cohort, sepsis rate was 6% [1%; 19%], 2/36 patients. The Charlson Comorbidity Index was the only predictor (p = 0.02). In the meta-cohort (13 cohorts, 2,369 patients), the combined sepsis rate was 12% [7%; 17%], despite high heterogeneity (I² = 75%), with no evidence of publication bias (p = 0.09). We identified younger age (p = 0.04), non-urethral urinary diversions (p = 0.04)-particularly ileal conduits (p < 0.001)-and non-traumatic etiologies (p = 0.02), especially spina bifida (p = 0.009), as predictors of sepsis.</p><p><strong>Conclusion: </strong>We recommend the development of a targeted antibiotic prophylaxis protocol, tailored to these predictors, for patients with neurogenic bladder undergoing percutaneous nephrolithotomy. We motivate further research on causal pathways.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"440"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650718","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":"PSA proportion of index lesion: a novel index for predicting prostate pathology outcomes in biopsy-naïve patients with PSA < 10 ng/ml and PI-RADS 3 lesions.","authors":"Haojie Mo, Can Hu, Peng Li, Zhijun Miao, Haoyang Zhang, Gang Shen, Jiale Sun","doi":"10.1007/s00345-025-05810-2","DOIUrl":"https://doi.org/10.1007/s00345-025-05810-2","url":null,"abstract":"<p><strong>Objective: </strong>To validate a novel marker, called prostate-specific antigen (PSA) proportion of index lesion (PPIL), that could predict prostate pathology outcomes in biopsy-naïve patients with PSA levels < 10 ng/ml and Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions.</p><p><strong>Methods: </strong>This study included 356 men retrospectively from 2019 to 2024 in cohort 1 (training set and internal validation set, The First Affiliated Hospital of Soochow University). Between 2020 and 2024, 158 men were included in cohort 2 (external validation set, The Fourth Affiliated Hospital of Soochow University). The volume of all index lesions was calculated using the Slicer-3D software. Logistic regression analysis was performed for variables including PPIL and classic parameters of prostate cancer (PCa) in cohorts 1 and 2. Receiver operating characteristic curve analysis was performed, and the area under the curve (AUC) was calculated to assess utility.</p><p><strong>Results: </strong>In total, 100 (28.1%) patients were diagnosed with PCa in cohort 1, and 51 (51.0%) had clinically significant prostate cancer (CsPCa). In cohort 2, 55 patients (34.8%) were diagnosed with PCa. Among these, 33 (60.0%) had CsPCa. Age, prostate volume, prostate-specific antigen density, lesion volume and PPIL were predictive factors for PCa and csPCa. The highest AUC of PPIL was noted in the training set and internal and external validation sets for PCa (0.743, 0.767, and 0.750) and csPCa (0.778, 0.927, and 0.766), respectively.</p><p><strong>Conclusion: </strong>PPIL may be a useful marker for predicting prostate pathology outcomes in biopsy-naïve patients with PSA level < 10 ng/ml and PI-RADS 3 lesions. This novel index may assist urologists in biopsy decision making for these so-called \"double gray zone\" patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"444"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660405","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: \"comparative analysis of the performance of the large language models DeepSeek-V3, DeepSeek-R1, OpenAI o3-mini and OpenAI o3-mini high in urology\".","authors":"Shafiullah","doi":"10.1007/s00345-025-05832-w","DOIUrl":"https://doi.org/10.1007/s00345-025-05832-w","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"446"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660490","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":"Novel risk predictor of spontaneous rupture and hemorrhage of renal cell carcinoma based on clinical and radiographic characteristics.","authors":"Bin Lin, Xiao-Dong Li, Meng-Xin Liu, Yu-Ting Xue, Xu-Yun Huang, Zhi-Bin Ke, Jia-Yin Chen, Fei Lin, Qing-Shui Zheng, Yong Wei, Xue-Yi Xue, Shao-Hao Chen, Ning Xu","doi":"10.1007/s00345-025-05819-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05819-7","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate and validate clinical and imaging predictors of spontaneous rupture and hemorrhage (SRH) in renal cell carcinoma (RCC), and to develop an individualized risk prediction nomogram.</p><p><strong>Methods: </strong>A cohort of 914 RCC patients was analyzed. Clinical and imaging characteristics were compared between SRH and non-SRH groups, with baseline characteristics balanced using propensity score matching. Univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis were performed to identify SRH risk factors. A predictive nomogram was constructed and internally validated.</p><p><strong>Results: </strong>After matching, baseline characteristics were comparable. Protective factors against SRH included posterior perirenal fat thickness (HR_{1 - 1.9 cm}=0.25,HR_≥ 2 cm=0.12) and solid tumor (HR = 0.48). Conversely, perinephric fat stranding (HR_Type1=2.68, HR_Type2=5.13) and the renal tumor vascular-to-renal artery diameter ratio (HR = 15.08) were identified as significant risk factors. ROC analysis showed AUCs of 0.70 for perirenal fat thickness, 0.61 for the diameter ratio, and 0.80 for the SRH prediction model. The nomogram demonstrated moderate discrimination, acceptable calibration, and clinical utility. Patients with fumarate hydratase deficiency exhibited characteristic CT findings of cystic-solid tumors, reduced perirenal fat thickness, and an increased tumor diameter ratio.</p><p><strong>Conclusions: </strong>Perinephric fat stranding and the renal tumor vascular-to-renal artery diameter ratio are significant risk factors for SRH in RCC, while perirenal fat thickness and solid tumors are protective. Patients with fumarate hydratase deficiency are at increased SRH risk and require special clinical attention. The developed nomogram may assist in individualized risk assessment and clinical decision-making.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"441"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660491","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":"Stone culture, bladder or pelvic urine culture: the most helpful tool for an endourologist - a review of literature from EAU section of endourology.","authors":"Francesco Ripa, Ayah Atiya, Alberto Quistini, Clara Cerrato, Vineet Gauhar, Bhaskar Somani","doi":"10.1007/s00345-025-05558-9","DOIUrl":"10.1007/s00345-025-05558-9","url":null,"abstract":"<p><strong>Purpose: </strong>Urosepsis is a potential life-threatening complication of minimally invasive endourological procedures. High discordance rates exist between bladder urine cultures and cultures from the upper tract (renal pelvis and stones cultures). Aim of this systematic review is to summarise the evidence on the clinical value of pre-operative bladder urine culture (PBUC), renal pelvis urine culture (RPUC) and stone cultures (SC) in predicting post-operative infective complications after URS or PCNL.</p><p><strong>Methods: </strong>A systematic review was performed in accordance to the PRISMA guidelines. The PICO model of the clinical search question was: Patients - patients undergoing PCNL or URS; Intervention - intra-operative RPUC and SC; Comparison - compared to pre-operative BUC; Outcome - prediction of post-operative systemic inflammatory response syndrome (SIRS) or sepsis. Studies included were published between 2004 and 2024.</p><p><strong>Results: </strong>21 studies were included. PBUC was shown to have a poor concordance rate with intra-operative cultures. PBUC had a lower value in predicting post-operative SIRS and sepsis compared to intra-operative cultures. A significant concordance rate was found between RPUC and SC. SC were the best predictors of the development of post-operative SIRS and urosepsis.</p><p><strong>Conclusion: </strong>A pre-operative bladder urine culture is often not representative of the upper tract microbiological environment. Collecting renal pelvis urine cultures and stone cultures during RIRS and PCNL should be the standard of care, especially in high risk patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"447"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660406","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":"PSA density correlates to pathology T stage and ISUP grade: insights from a cohort of 3568 radical prostatectomy cases.","authors":"Maxime Pattou, Yann Neuzillet, Tarek Ghoneim, Pierre-Olivier Bosset, Jean-Marie Herve, Victor Vanalderwerelt, Denis Bohin, Pierre-Marie Lugagne, Yanish Soorojebally, Thierry Lebret","doi":"10.1007/s00345-025-05814-y","DOIUrl":"https://doi.org/10.1007/s00345-025-05814-y","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate-specific antigen density (PSAD) is a valuable detection tool for prostate cancer (PCa) with PSA levels in the \"gray zone\" (4-10 ng/mL). However, its relationship with final pathology outcomes remains limited, especially on large cohorts.</p><p><strong>Objective: </strong>This study aimed to describe PSAD distributions according to final pathology findings (pathological T stage and ISUP grade) and identify clinical and pathological factors influencing PSAD variations.</p><p><strong>Methods: </strong>We analyzed a prospective cohort of 3568 patients who underwent radical prostatectomy for PCa in our center between 2007 and 2025. PSAD was calculated using serum PSA (ng/mL) divided by prostate weight (g) from pathology reports. Associations between PSAD and pathology T stage, ISUP grade, total testosterone, cholesterol levels, and statin use were done using Spearman's correlation coefficient, stratified rank ANCOVA analysis and a multiple linear regression.</p><p><strong>Results: </strong>The median PSAD was 0.17 ng/mL/g (IQR: 0.12-0.25). PSAD levels increased gradually with advanced pathology T stage (pT3a and T3b) and higher ISUP grade (p < 0.001 for both). After adjusting for confounding covariates (age and D'Amico risk classification), PSAD remained significantly associated with Pathology T stage and ISUP. Within the high-risk category, high biopsy ISUP and pathology ISUP grades were associated with lower PSAD levels (r = -0.59 and - 0.49 respectively). PSAD levels were associated with four adverse pathology outcomes, namely positive surgical margins, nodal involvement, ISUP ≥ 4 upgrading and pT ≥ 3 upstaging. Multivariate analysis identified higher biopsy ISUP grade and PSA levels as positive predictors of PSAD, while age, BMI, and testosterone were negatively associated.</p><p><strong>Conclusion: </strong>PSAD correlates with PCa aggressiveness on pathology, making it a clinically relevant biomarker. Future studies should investigate PSAD's relation with adverse oncological outcomes, including biochemical recurrence.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"445"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660404","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":"Reinforcing expectations after robot-assisted intracorporeal orthotopic neobladder: long-term functional, urodynamic and metabolic outcome.","authors":"Pia Kraft, Christoph Schregel, Fabian Obrecht, Beat Foerster, Gabriel Froelicher, Orlando Burkhardt, Katharina Boehler, Christian Padevit, Jure Tornic, Peter Wiklund, Hubert John","doi":"10.1007/s00345-025-05821-z","DOIUrl":"https://doi.org/10.1007/s00345-025-05821-z","url":null,"abstract":"<p><strong>Purpose: </strong>Robotic-assisted radical cystectomy (RARC) with complete intracorporeal orthotopic neobladder offers a less invasive reconstruction of continent urinary diversion to the open approach. The aim was to evaluate long-term functional, urodynamic, and metabolic outcomes after RARC with intracorporeal orthotopic neobladder.</p><p><strong>Methods: </strong>In this retrospective study, 18 consecutive patients (16 men, median age 67 years) undergoing RARC for urothelial carcinoma with intracorporeal orthotopic neobladder between November 2015 and May 2021 were included. Video urodynamic evaluations assessed neobladder capacity, pressure at maximum filling, ureteral reflux and post-void residual volume. Continence was evaluated by questionnaires and pad count. Laboratory values were retrieved from the clinic information system. A subgroup of patients underwent both early and a late with video urodynamic studies were performed.</p><p><strong>Results: </strong>Median time between RARC with intracorporeal orthotopic neobladder reconstruction and late postoperative studies was 60 months. Urodynamic measurements showed a median maximum neobladder capacity of 485 mL (interquartile range (IQR), 433-625) and a maximum neobladder pressure of 20 cmH₂O (IQR, 11-25). The daytime continence rate (≤ 1 pad) was 89% (16/18 patients), while the nighttime rate was 61% (11/18 patients). Intermittent self-catheterization was needed in 28%. Bicarbonate substitution was required in 22% (4/18) of patients. In 50% (9/18) of patients with an additional early postoperative study after 11 months, urodynamic, functional, and metabolic changes were stable between early and late studies (all, p > 0.05).</p><p><strong>Conclusions: </strong>This patient series reports comprehensive long term urodynamic, functional, and metabolic results five years after RARC with intracorporeal orthotopic neobladder reconstruction. In a subgroup analysis, neobladder function, renal function, and metabolic status remained stable between early and late postoperative assessments, which may indicate favorable long-term outcomes.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"437"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643658","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":"Reconstructive versus palliative management of ureteral stenosis after kidney transplant: an EAU‑YAU kidney transplantation working group collaboration.","authors":"Gianpaolo Lucignani, Anna Rivetti, Thomas Prudhomme, Alessio Pecoraro, Beatriz Bañuelos Marco, Alberto Piana, Alicia López-Abad, Muhammet Irfan Dönmez, Hakan Bahadir Haberal, Angelo Territo, Romain Boissier","doi":"10.1007/s00345-025-05824-w","DOIUrl":"10.1007/s00345-025-05824-w","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical redo of the anastomosis is the recommended treatment of ureteral stenosis (US) after kidney transplantation (KT), although some patients may only be candidates for palliative treatment by permanent urinary catheterization. We aimed to compare the functional results of these two approaches.</p><p><strong>Methods: </strong>This was a retrospective, multicenter study conducted at 3 academic centers. All patients presenting ureteral stenosis after kidney transplant treated by either surgical reconstruction or indwelling ureteral stent were included. Treatment allocation was established based on strictures characteristics and patient preference. The outcomes of each procedure and factors associated with success of reconstruction, graft failure and eGFR variation were analyzed by means of descriptive statistics.</p><p><strong>Results: </strong>30 (54.5%) and 24 (44.5%) patients underwent reconstructive and palliative treatment, respectively. Distal/ureterovesical location was most frequently observed (81.1%, p < 0.0001). Reconstruction consisted of ureterovesical reimplantation, pyeloureterostomy and ureteroureterostomy in 11 (36.6%), 13 (43.3%) and 3 (10.0%) cases, respectively. Intestinal segment interposition was employed in 2 (6.7%) cases. We observed 4 (13.3%) cases of failure after surgery and ureterovesical reimplantation was significantly associated with stricture recurrence (p = 0.018). A significant variation of eGFR from post treatment baseline to last follow-up was observed in the palliative group (43.5 ml/ min/ 1.73 m² to 32.0 ml/ min/ 1.73 m², p < 0.001), although graft survival was similar (91.9% vs. 90.0%, p = 0.65).</p><p><strong>Conclusion: </strong>Surgical reconstruction can attain definitive treatment of post KT US in almost nine out of ten patients with a satisfactory safety profile. On the other hand, palliative treatment seems to be associated with eGFR degradation.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"439"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643657","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":"Unicorns transforming the practice of urology: value creation and allocation in the digital age.","authors":"Philipp Erben, Severin Rodler, Amin T Turki, Ulrich Witzsch, Christian Thielscher","doi":"10.1007/s00345-025-05828-6","DOIUrl":"10.1007/s00345-025-05828-6","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze what kind of products and services unicorns, which create a substantial financial value, provide in urology and what this means for the future of urological practice. So far, the added value of unicorns has hardly been utilised for medical research, although a fraction of it would be enough to multiply the funds for urological research.</p><p><strong>Methods: </strong>All medical unicorns (as by end of 2024) were studied, and urological unicorns identified. Publicly available data on valuation, investors, business operations and geographic distribution were analyzed to determine entrepreneurial purpose and value creation in urology.</p><p><strong>Results: </strong>Among the 21 unicorns in urology, the majority operate in drug research, including artificial intelligence guided development; this is in line with the digital transformation of medicine. Yet, business models are diversified. The valuations range from $ bn 1.0 to 7.83, summing to a total value of $ bn 56.2. The overwhelming majority (90%) is based in the US, one in China and one in UK.</p><p><strong>Conclusion: </strong>Unicorns in urology have accumulated substantial financial impact, which may accelerate medical progress but also creates risks (such as creating inequity). These developments will likely impact the practice of urology and deserve more scientific research to inform medical societies and policy decision making.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"436"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643659","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}