The Canadian journal of urology最新文献

{"title":"Clinical spectrum of retroperitoneal Castleman disease: retrospective analysis of 59 cases in a single Chinese medical center.","authors":"Ting Zhu, Junjie Tian, Chuan Wang, Zhishang Li, Yanfeng Bai, Shien Rao, Ping Wang","doi":"10.32604/cju.2026.077709","DOIUrl":"10.32604/cju.2026.077709","url":null,"abstract":"<p><strong>Backgrounds: </strong>Castleman disease (CD) is a rare lymphoproliferative disorder. While its general clinical and pathological features are well-described, detailed data on retroperitoneal CD-a diagnostically challenging location-remain scarce. This study characterizes the clinicopathological profile, management, and long-term outcomes of retroperitoneal CD. The aim of this study is to clarify the clinical and therapeutic characteristics of retroperitoneal CD, and to provide practical evidence for its accurate diagnosis and individualized management in clinical practice.</p><p><strong>Methods: </strong>A retrospective analysis of 59 patients with pathologically confirmed retroperitoneal CD (September 2010-December 2025) was conducted at a single center. Patients were classified as unicentric CD (UCD) or multicentric CD (MCD), with demographic, clinical, imaging, treatment, and follow-up data analyzed.</p><p><strong>Results: </strong>The cohort included 52 UCD and 7 MCD patients. UCD patients were younger (median 38 vs. 56 years, p = 0.021), predominantly female (65.40%), and asymptomatic (65.40%). All MCD patients presented with systemic inflammatory symptoms. Perirenal location was the most common (36.54% of UCD). CT consistently showed well-circumscribed, hypervascular masses with intense arterial enhancement. Complete surgical resection of UCD achieved 100% disease-free survival (median follow-up 98.5 months). Multidisciplinary management (surgery, corticosteroids, or rituximab-based therapy) achieved disease control in all MCD patients.</p><p><strong>Conclusions: </strong>Retroperitoneal UCD and MCD are distinct entities. UCD, a typically hyaline vascular type, is often incidentally detected and curable by complete surgical excision. MCD, usually plasma cell type with systemic symptoms, requires systemic therapy. Accurate preoperative diagnosis is critical to guide curative surgery for UCD and multidisciplinary management for MCD.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"977-987"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From bedroom to boardroom: erectile dysfunction as a window into cardiovascular health.","authors":"Andres H Guillen Lozoya, Milad Bonakdarhashemi, Sevann Helo, Matthew Ziegelmann, Tobias Kohler","doi":"10.32604/cju.2026.075775","DOIUrl":"https://doi.org/10.32604/cju.2026.075775","url":null,"abstract":"<p><p>Erectile dysfunction (ED) has evolved from a quality-of-life concern to a recognized marker of systemic vascular disease and an early harbinger of cardiovascular events. The Princeton IV Consensus underscores that men presenting with erectile dysfunction should be presumed at increased cardiovascular risk until proven otherwise, advocating integrated risk stratification and lifestyle optimization. Beyond established risk scores, advances in omics, vascular imaging, and digital health promise precision tools for early detection and prevention. This review aims to examine erectile dysfunction as an early marker of cardiovascular disease and to summarize current and emerging approaches to cardiovascular risk stratification in men with ED.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"923-930"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine uropathy: an update on pathophysiology, complications, and treatment options.","authors":"Derrick Tsang, Ioannis Loufopoulos, Konstantinos Kapriniotis, Hannah Danbury, Ioannis Manolitsis, Stamatios Katsimperis, Senol Tonyali, Patrick Juliebø-Jones, Lazaros Tzelves, Neha Sihra, James Green","doi":"10.32604/cju.2026.075625","DOIUrl":"https://doi.org/10.32604/cju.2026.075625","url":null,"abstract":"<p><p>Ketamine is a potent anaesthetic drug that has been used for decades. Ketamine abuse is an increasingly common problem, particularly among young people. Over one quarter of ketamine users will have at least one bothersome urological symptom, with heavier and longer use leading to potentially irreversible damage to the lower and upper urinary tract. Hence, this study carried out a narrative review focusing on ketamine-induced uropathy pathophysiology, clinical presentation, and treatment options. It was found that ketamine uropathy is an inflammatory condition affecting predominantly the bladder but also the upper urinary tracts. A hypersensitivity reaction to the drug has been proposed as the potential pathophysiological mechanism that causes inflammatory reaction, muscle hypertrophy, and non-reversible fibrosis in the advanced stages of the disease. Abstinence from ketamine use is the cornerstone of treatment at any stage of the disease, with effective pain management and psychological support being critical to reduce ketamine seeking behaviours. For mildly symptomatic patients, minimally invasive options such as bladder instillations and intravesical Botox injections can provide symptomatic relief. For more severe cases with refractory symptoms and upper urinary tract involvement, reconstructive urological operations might be necessary, including augmentation cystoplasty, cystectomy, or ureteric reconstruction. Ongoing surveillance of the upper tracts is recommended for both groups of patients. Ketamine induced uropathy is an increasingly prevalent condition, and ketamine abuse should always be inquired about in people with unexplained lower urinary tract symptoms. Adequate information of the public regarding ketamine abuse and early consultation with a urologist might prevent irreversible damage.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"771-782"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unintended consequences of antibiotic practices: the relationship between bowel preparation, prolonged prophylaxis, and ileus after radical cystectomy.","authors":"Sri Saran Manivasagam, Joseph Y Clark, Jay D Raman","doi":"10.32604/cju.2026.078196","DOIUrl":"https://doi.org/10.32604/cju.2026.078196","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative ileus (POI) after radical cystectomy (RC) is a common complication that carries significant morbidity. Prolonged antibiotic usage has been associated with an elevated risk of POI. The American Urological Association guidelines recommend that only a single dose of peri-procedural antibiotic prophylaxis is sufficient. This study aims to evaluate the association between oral antibiotic bowel preparation (ABP) and prolonged surgical antibiotic prophylaxis (SAP) (>24 h) with postoperative ileus (POI) following radical cystectomy (RC).</p><p><strong>Materials and methods: </strong>A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted RC dataset was performed. Patients with clinical indications for extended antibiotic use were excluded. POI was defined as nil per os status, or nasogastric tube use beyond postoperative day three, or reinstitution of either on or after day four. Clinical, perioperative and oncological characteristics were compared between patients to identify factors associated with POI.</p><p><strong>Results: </strong>Among 5098 patients undergoing RC, the incidence of POI was 12.4%. A small fraction of patients received ABP (6.5%), mechanical bowel preparation (MBP) was given to 22.1% of patients, and 23.4% patients received SAP for more than 24 h. On univariate analysis, ABP (Odds ratio (OR) 1.711), open surgical approach (OR 1.542), prior pelvic radiotherapy (OR 1.515), age > 65 years (OR 1.386), SAP > 24 h (OR 1.378), and receipt of chemotherapy within 90 days (OR 1.220) were associated with POI. However, on multivariate analysis, only oral ABP (OR 1.692, p = 0.009), SAP > 24 h (OR 1.460, p = 0.04), and age > 65 years (OR 1.361, p = 0.031) remained independently significant.</p><p><strong>Conclusions: </strong>Oral ABP and prolonged SAP are associated with increased risk of POI following RC. These findings underscore the importance of adherence to evidence-based perioperative protocols and antibiotic stewardship to improve postoperative outcomes in urologic oncology.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"865-871"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of leuprolide and goserelin on androgen suppression and adverse events in patients with prostate cancer.","authors":"Carla Simone Moreira Freitas, Fabiana Rocha-Silva, Thaís Almeida Marques-Silva, Ana Carolina Ribeiro de Oliveira, Sérgio Gomes da Silva, Fabrizio Dos Santos Cardoso, Aleida Nazareth Soares","doi":"10.32604/cju.2026.069559","DOIUrl":"10.32604/cju.2026.069559","url":null,"abstract":"<p><strong>Background: </strong>Androgen deprivation therapy (ADT) is widely employed in the management of advanced prostate cancer, with luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide and goserelin being common options. However, pharmacological and metabolic differences between these agents may affect the efficacy of hormonal suppression and adverse event profiles. This study compared the effects of leuprolide (22.5 and 45 mg) and goserelin (10.8 mg) on prostate-specific antigen (PSA) and testosterone reduction, as well as their metabolic and cardiovascular impacts and the influence of genetic variants on therapeutic response.</p><p><strong>Methods: </strong>A prospective, randomized, controlled study was conducted with 174 patients diagnosed with prostate cancer and treated with ADT for 12 months. Serum PSA and testosterone levels, lipid and glycemic profiles, and adverse events were monitored. Genetic analyses were performed to identify mutations in the TP53, BRCA1, BRCA2, and ATM genes.</p><p><strong>Results: </strong>All treatment groups exhibited significant reductions in PSA and testosterone levels. Leuprolide 22.5 mg achieved the most pronounced PSA reduction, whereas goserelin 10.8 mg demonstrated greater variability in testosterone during the early months of therapy. Hot flashes were the most frequent adverse event, reported in 90% of patients treated with leuprolide 22.5 mg, while cardiovascular events were more prevalent in the goserelin 10.8 mg group. The TP53 gene was the most frequently altered (20.4%), followed by BRCA2 (7.4%) and ATM (6.5%), though these mutations did not significantly affect treatment response.</p><p><strong>Conclusion: </strong>ADT effectively achieves hormonal suppression in prostate cancer; however, differences between LHRH agonists influence clinical and metabolic outcomes. Leuprolide 22.5 mg showed superior PSA reduction but higher rates of vasomotor symptoms and weight gain, while goserelin 10.8 mg was associated with hormonal instability and cardiovascular risk. Genetic findings suggest that BRCA2 variants may affect lipid metabolism, reinforcing the need for personalized ADT strategies integrating metabolic and genetic profiles.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"827-839"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous blood coagulum for fragment removal after ureteroscopic laser lithotripsy.","authors":"Tiffany R Huang, Bruce M Gao, Aymon Ali, Mariah C Hernandez, Christopher D Yang, Jonathan Badin-Castro, Carol Davis-Dao, Helen Gao, Seyedamirvala Saadat, Seyed Amiryaghoub M Lavasani, Sohrab N Ali, Pengbo Jiang, Roshan M Patel, Jaime Landman, Ralph V Clayman","doi":"10.32604/cju.2026.077477","DOIUrl":"https://doi.org/10.32604/cju.2026.077477","url":null,"abstract":"<p><strong>Background: </strong>Ureteroscopy is the recommended surgical treatment for renal stones less than two centimeters in diameter but often leaves residual fragments, increasing the risk of stone recurrence. Autologous blood coagulum is a potential adjunct to ureteroscopy for aiding fragment retrieval. This study evaluates the efficacy and efficiency of autologous blood coagulum assisted ureteroscopy compared to ureteroscopy and basketing for achieving absolute stone-free Grade A status.</p><p><strong>Methods: </strong>Following Institutional Review Board approval, a retrospective review of our comprehensive UC Irvine Minimally Invasive Surgery Ureteroscopy database consisting of 962 patients undergoing ureteroscopy between 2018 to 2025 identified 15 renal units treated with ureteroscopy plus autologous blood coagulum and 47 matched controls treated with standard ureteroscopy and basketing alone. Primary outcomes included absolute stone-free status and stone-free rate, with operative time as a secondary outcome. Multivariate logistic regression was used to determine factors most closely associated with stone-free status.</p><p><strong>Results: </strong>Autologous blood coagulum increased the proportion of patients achieving absolute stone-free Grade A status (60% vs. 19%; p = 0.007) and was associated with a greater odds of achieving Grade A status compared to standard ureteroscopy (OR = 4.6; 95% CI = 1.04-20.1; p = 0.044). In patients who received autologous blood coagulum, thulium laser use was associated with a significantly greater odds of achieving Grade A status (OR 6.7; 95% CI: 1.1-39; p = 0.047). There was no significant difference in the relative stone free rates for fragments ≤4 mm (Grades A+B+C) between groups (73% vs. 60%; p = 0.38). Mean operative time for autologous blood coagulum vs. the control group was comparable (141.1 vs. 135.1 min; p = 0.76).</p><p><strong>Conclusions: </strong>Autologous blood coagulum is an effective adjunctive technique to standard ureteroscopy that enhances stone-free outcomes without prolonging operative duration or requiring any additional equipment or expense.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"885-892"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary malignant melanoma of the female urethra: a case report and literature review.","authors":"Jianlin Xie, Qingwei Zhang, Jingde Wu, Yingjun Ma, Yujie Yan, Xiande Huang","doi":"10.32604/cju.2026.076571","DOIUrl":"https://doi.org/10.32604/cju.2026.076571","url":null,"abstract":"<p><strong>Background: </strong>Primary urethral malignant melanoma is an extremely rare malignancy of mucosal origin. Its clinical manifestations are non-specific, often leading to misdiagnosis or delayed diagnosis. Due to its highly aggressive nature and propensity for early metastasis, patient prognosis is generally poor.</p><p><strong>Case description: </strong>This case report describes an 81-year-old Chinese female patient who presented to the Department of Urology at Gansu Provincial Hospital with the chief complaint of \"a black mass at the external urethral meatus accompanied by urinary incontinence for two months. Physical examination revealed a dark, protruding mass at the external urethral orifice. Imaging studies showed no evidence of distant metastasis. The patient underwent a \"Radical Resection of Urethral Mass.\" Due to significant urethral shortening following tumor resection, a concurrent \"retropubic urethropexy\" was performed to preserve postoperative urinary continence. Postoperative pathology and immunohistochemistry confirmed the diagnosis of malignant melanoma. The patient declined adjuvant targeted therapy postoperatively. Short-term follow-up indicated no tumor recurrence, with satisfactory recovery of urinary function.</p><p><strong>Conclusions: </strong>For primary urethral malignant melanoma, radical surgical resection remains the primary treatment modality. In this case, the combination of radical surgery with a concurrent urethropexy procedure achieved complete tumor removal while effectively preventing postoperative urinary incontinence resulting from local anatomical disruption. This approach highlights the importance of individualized, multifunction-preserving treatment strategies for such rare cases. Enhancing clinical awareness of this disease is crucial for facilitating early diagnosis and improving patient prognosis.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"1027-1033"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Ewing sarcoma with an unusual presentation: a case report.","authors":"Felix Lübbersmeyer, Paula Lindfeld, Margit Fisch, Roland Dahlem, Markus Von Deimling","doi":"10.32604/cju.2026.076969","DOIUrl":"https://doi.org/10.32604/cju.2026.076969","url":null,"abstract":"<p><strong>Backgrounds: </strong>Ewing Sarcoma (ES) is an aggressive pediatric bone tumor requiring multimodal treatment. Primary renal ES is extremely rare and often presents with nonspecific symptoms, potentially delaying diagnosis. Imaging aids detection, while histopathological and molecular analyses confirm the diagnosis.</p><p><strong>Case description: </strong>We report on a 31-year-old female who was initially treated for pyelonephritis. As computerized tomography suggested a malignant kidney tumor with an extensive inferior vena cava thrombus, nephrectomy and caval ligation were performed. Histopathology and further staging confirmed primary renal ES, which was subsequently treated with adjuvant polychemotherapy.</p><p><strong>Conclusions: </strong>The present case highlights the variable clinical spectrum of malignant kidney tumors. ES should be considered in the differential diagnosis of atypical renal masses.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"1019-1025"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of interstitial cystitis with intravesical instillation of recombinant human collagen type Ⅲ.","authors":"Xiaokai Shi, Li Zuo","doi":"10.32604/cju.2026.074350","DOIUrl":"https://doi.org/10.32604/cju.2026.074350","url":null,"abstract":"<p><strong>Background: </strong>Interstitial cystitis (IC) is a chronic condition characterized by frequent urination, urgency, and pelvic pain. While its pathogenesis remains incompletely understood, the prevailing epithelial theory suggests that a defective glycosaminoglycan (GAG) layer increases bladder permeability, allowing urinary toxins to chronically stimulate the detrusor muscle and activate mast cells. Current therapies, such as intravesical hyaluronic acid instillation, have demonstrated limited efficacy. This study aimed to evaluate the feasibility of sterile recombinant human collagen type III (rHCIII) in mitigating bladder injury and its histological effects on urothelial integrity.</p><p><strong>Method: </strong>An IC rat model was established using protamine sulfate and lipopolysaccharide. The model was subsequently treated with sterile rHCⅢ via bladder instillation. Bladder tissues were analyzed using Hematoxylin-eosin (H&E) staining for general histopathology, Masson and van Gieson staining for collagen fiber organization, and Toluidine blue (TB) staining for mast cell infiltration. Apoptosis was assessed by Terminal Deoxynucleotidyl Transferase mediated dUTP Nick-End Labeling (TUNEL) staining and immunohistochemistry for Caspase-3. The localization of the perfused rHCⅢ was tracked using immunohistochemistry for a 6×Histidine (HIS) tag.</p><p><strong>Result: </strong>Immunohistochemistry confirmed the presence of rHCⅢ in the bladder mucosal and submucosal layers. Treatment with rHCⅢ significantly reduced bladder cell apoptosis compared to the IC group (p < 0.001). Furthermore, the collagen fibers in the submucosal and muscular layers demonstrated a more compact and organized arrangement post-treatment. Mast cell infiltration was also markedly diminished following rHCⅢ instillation (p < 0.001).</p><p><strong>Conclusion: </strong>Intravesical instillation of sterile rHCⅢ mitigates apoptosis of mucosal epithelial cells and reinforces the submucosal collagen structure. This intervention promotes a more organized tissue architecture, which may help maintain urothelial structural integrity. These findings provide preclinical evidence supporting the repair-oriented potential of rHCⅢ instillation for interstitial cystitis.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"851-864"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of percutaneous sampling in Bosniak III-IV renal cysts: a systematic review and meta-analysis.","authors":"Attilio Barretta, Angelo Mottaran, Nicolas Carl, Francesco Prata, Sara Tamburini, Edoardo Beatrici, Mario De Angelis, Francesco Cei, Natali Rodriguez Peñaranda, Francesco Pepillo, Alessio Guidotti, Vincenzo Cavarra, Claudio Brancelli, Pietro Pasquini, Pietro Piazza, Cristian Vincenzo Pultrone, Hussam Dababneh, Lorenzo Bianchi, Alessandro Larcher, Alexandre Mottrie, Rocco Papalia, Riccardo Schiavina","doi":"10.32604/cju.2026.078354","DOIUrl":"10.32604/cju.2026.078354","url":null,"abstract":"<p><strong>Objectives: </strong>Complex cystic renal lesions pose a significant diagnostic challenge in the preoperative assessment of malignancy. Although percutaneous renal mass biopsy is well established for solid tumours diagnosis, its role in cystic lesions remains controversial. This systematic review aims to evaluate the diagnostic performance, safety, and clinical impact of percutaneous sampling-fine-needle aspiration (FNA) and core needle biopsy (CNB)-in Bosniak III-IV renal cysts.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [International Prospective Register of Systematic Reviews (PROSPERO) ID CRD420251124563]. PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science were searched (1980-May 2025). Eligible studies included adult patients with Bosniak III-IV cysts undergoing FNA or CNB. Pooled diagnostic estimates were calculated using a bivariate random-effects model.</p><p><strong>Results: </strong>Seven studies, including 954 patients, met the inclusion criteria. Three studies evaluated FNA, yielding a pooled sensitivity of 59% [95% Confidence Interval (CI): 14-93], specificity of 84% (95% CI: 62-94), and an overall diagnostic performance of 0.84 [Area under the curve (AUC)]. Sensitivity estimates varied widely, whereas specificity was consistently high. Four studies assessed CNB, reporting diagnostic yields between 75% and 81%. Cystic morphology was identified as the strongest independent predictor of non-diagnostic sampling, with odds ratios (OR) up to 13.9. No major complications or cases of tumour seeding were reported across the included studies. Reporting of minor complications was limited and heterogeneous, precluding a pooled analysis.</p><p><strong>Conclusions: </strong>Percutaneous sampling of Bosniak III-IV cystic renal masses is feasible but diagnostically challenging. FNA provides limited value due to high rates of non-diagnostic and false-negative results. CNB achieves higher accuracy, particularly when a solid component is present, and may be considered within a multidisciplinary setting when histological confirmation is likely to influence treatment decisions.</p>","PeriodicalId":520500,"journal":{"name":"The Canadian journal of urology","volume":"33 4","pages":"783-793"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}