Frontiers in urology最新文献

{"title":"Effect of prior diverse surgical histories on the efficacy and safety of one-stage retrograde intrarenal surgery in patients with renal stone: a retrospective study.","authors":"Daocheng Fang, Dong Mingyuan, Shuangquan Sun, Hui Wang, Hui Wen","doi":"10.3389/fruro.2026.1735018","DOIUrl":"10.3389/fruro.2026.1735018","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the influence of a history of percutaneous nephrolithotomy (PCNL) and a history of retrograde intrarenal surgery (RIRS) on the efficacy and safety of one-stage RIRS in patients with renal stones.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 115 patients with renal stones who underwent one-stage RIRS from January 2022 to June 2025. These patients were divided into three groups: group A (with a history of PCNL) comprising 28 cases, group B (with a history of RIRS) comprising 37 cases, and group C (without a history of urinary stone surgery) comprising 50 cases. The operative time, postoperative hospital stay, postoperative increase in serum creatinine levels, complication rate, and stone-free rate (SFR) at 1 week and 4 weeks postoperatively were compared among the three groups. Linear regression was employed to identify independent predictors of operative time, while logistic regression was used to analyze independent factors influencing the stone-free rate at 4 weeks postoperatively and the occurrence of complications.</p><p><strong>Results: </strong>All patients in the three groups successfully completed the surgery. The operative time in group A was (61.5 ± 8.9) min, which was significantly longer than that in group B [(53.4 ± 6.3) min] and group C [(51.0 ± 6.7) min] (<i>P</i> < 0.01). There were no significant differences in the postoperative hospital stay among group A [(2.2 ± 0.8) d], group B [(2.2 ± 0.7) d], and group C [(2.1 ± 0.3) d] (<i>P</i>>0.05). No significant differences were observed in the postoperative increase in serum creatinine levels among group A [(12.23 ± 8.68) μmol/L], Group B [(13.34 ± 9.11) μmol/L], and group C [(12.16 ± 8.38) μmol/L] (<i>P</i> > 0.05). The complication rate was 7.1% in group A, with no significant differences compared to 8.1% in group B and 8.0% in group C (<i>P</i> > 0.05). At 1 week postoperatively, the SFR was 64.2% in group A, with no significant differences compared to 62.2% in group B and 66.0% in group C (<i>P</i>>0.05); at 4 weeks postoperatively, the SFR was 85.7% in group A, with no significant differences compared to 89.2% in group B and 90.0% in group C (<i>P ></i>0.05). Multivariate logistic regression analysis demonstrated that a history of urinary stone surgery was not an independent influencing factor for the SFR at 4 weeks postoperatively or the occurrence of complications (P>0.05).</p><p><strong>Conclusion: </strong>A history of PCNL may prolong the operative time of one-stage RIRS, but it has no significant impact on the SFR or complication rate. A history of RIRS has no significant effect on the operative time, stone-free rate, or postoperative complication rate of one-stage RIRS. For patients with renal stones who have previously undergone PCNL or RIRS, one-stage RIRS represents an effective and safe treatment option.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"6 ","pages":"1735018"},"PeriodicalIF":1.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small cell prostate cancer: risks for metastatic disease.","authors":"Essam Al-Snayyan, Jamil Qiqieh, Cameron Peres, Sharon Tan, Susan Lyons, Avery Mendelson","doi":"10.3389/fruro.2026.1787906","DOIUrl":"10.3389/fruro.2026.1787906","url":null,"abstract":"<p><strong>Objective: </strong>To identify clinical and demographic factors associated with the presence and distribution of metastatic disease at diagnosis in patients with small cell carcinoma of the prostate (SCCP).</p><p><strong>Introduction: </strong>Small cell carcinoma of the prostate is a rare but highly aggressive subtype of prostate cancer, frequently presenting with distant metastases and poor survival outcomes. Despite its severity, population-level data examining predictors of metastatic disease at presentation remain limited. Understanding these factors may improve early detection and risk stratification.</p><p><strong>Methods: </strong>A retrospective, cross-sectional analysis was conducted using the SEER 17 registries (2000-2022). Patients with microscopically confirmed SCCP were identified using ICD-O-3 histology code 8041/3 and primary site code C61.9. Demographic, clinical, and metastatic variables were extracted. Univariate and multivariable logistic regression models were used to evaluate predictors of overall and site-specific metastases. Variables meeting a univariate threshold of p < 0.25 were included in multivariable models. Model assumptions were assessed using VIF, Tolerance, and Box-Tidwell tests.</p><p><strong>Results: </strong>A total of 541 patients were identified, of whom 71.7% presented with metastatic disease. The most common metastatic sites were bone (35.9%), liver (22.6%), lung (14.0%), and brain (3.9%). On multivariate analysis, a higher percentage of positive biopsy cores was independently associated with increased odds of metastatic disease. Younger age was associated with higher odds of brain metastasis. Lower household income and residence in metropolitan counties were associated with increased likelihood of metastatic disease, particularly bone metastases. Brain metastasis was strongly associated with concurrent liver and lung metastases, suggesting a pattern of widespread systemic involvement.</p><p><strong>Conclusions/discussion: </strong>Patients with SCCP frequently present with metastatic disease, and several clinical and socioeconomic factors influence metastatic risk. Higher tumor burden, lower income, metropolitan residence, and younger age were associated with a greater likelihood of metastasis at diagnosis. These findings highlight the importance of early diagnostic evaluation in high-risk groups and provide a foundation for improved prognostication and targeted care strategies in this rare and aggressive malignancy.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"6 ","pages":"1787906"},"PeriodicalIF":1.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrocele is a benign pathology, an appearance disorder: no, this may be a common misconception.","authors":"Ayhan Verit, Mert Verit, Fatma Ferda Verit","doi":"10.3389/fruro.2026.1760748","DOIUrl":"10.3389/fruro.2026.1760748","url":null,"abstract":"","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"6 ","pages":"1760748"},"PeriodicalIF":1.7,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low yield of pathological lymph node metastasis among patients with invasive penile squamous cell carcinoma in the context of high HIV burden: evidence from a prospective cohort study in Zambia.","authors":"Victor Mapulanga, Owen Ngalamika, Chibamba Mumba, Zoran Muhimbe, Curtis A Pettaway, Kasonde Bowa, Edford Sinkala","doi":"10.3389/fruro.2026.1727689","DOIUrl":"10.3389/fruro.2026.1727689","url":null,"abstract":"<p><strong>Introduction: </strong>Penile squamous cell carcinoma (PSCC) is common in developing countries such as those in sub-Saharan Africa (SSA) and has been attributed to a high prevalence of human papillomavirus (HPV). Additionally, since the prevalence of human immunodeficiency virus (HIV) is high in SSA, and considering that HIV causes reactive lymphadenopathy, this may potentially affect the clinical manifestation, including staging and surgical management, of inguinal lymph nodes in PSCC. Data on surgical staging via inguinal lymph node dissection (ILND) in penile cancer patients from areas of high HIV burden, such as SSA, are scanty. We evaluated the use of ILND as a staging tool to determine the status of inguinal lymph nodes in patients with invasive PSCC in the context of a high HIV burden.</p><p><strong>Methods: </strong>This was a prospective cross-sectional cohort study of participants recruited between November 2022 and January 2024 at the University Teaching Hospital in Lusaka, Zambia. Patients with surgically resectable PSCC who underwent surgery for both the primary tumor and inguinal lymph nodes simultaneously were recruited into the study. A questionnaire was administered to capture relevant clinical information. The dissected lymph nodes were pathologically analyzed for lymph node number, size, and the presence of metastasis.</p><p><strong>Results: </strong>Forty patients were enrolled in the study, with a mean age of 53 years (SD 10.28). Thirty-five patients (87.5%) were HIV seropositive, with most patients being virologically suppressed at the time of surgery. Thirty-two patients (80%) presented with clinically palpable inguinal lymph nodes (cN+). The yield of pathological lymph node metastasis (LNM) from surgical staging was 37.5% (12/32) among patients with clinically palpable (cN+) inguinal lymph nodes.</p><p><strong>Conclusion: </strong>The study demonstrates a modestly low yield of pathological inguinal lymph node metastasis in patients with clinically palpable nodes in the context of a high HIV burden. Minimally invasive biopsy techniques to assess nodal status should be explored in this setting to reduce the morbidity associated with surgical staging while accurately assessing nodal status.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"6 ","pages":"1727689"},"PeriodicalIF":1.7,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12945773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extraplanar ultrasound-guided multi-tract percutaneous nephrolithotomy: a retrospective comparative study in patients with complex nephrolithiasis.","authors":"Geng-Geng Wei, Kristine J S Kwan, Yu Yang, Qing-Shan Yang, Zhen-Quan Lu, Lin Xiong, Xiang Xu","doi":"10.3389/fruro.2026.1713534","DOIUrl":"10.3389/fruro.2026.1713534","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the efficacy and safety of extraplanar ultrasound (USG) guidance with the conventional technique in multi-tract percutaneous nephrolithotomy (PCNL) for managing complex renal stones (CRS).</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 91 patients diagnosed with CRS treated with multi-tract PCNL between May 2017 and December 2020. Patients were divided into the conventional USG group and the extraplanar USG group. Patient demographics and operative characteristics were compared, acknowledging the baseline stone size imbalance as a potential confounder.</p><p><strong>Results: </strong>Fifty-one (56.0%) patients received extraplanar USG-guided PCNL. The median maximum stone diameter in the conventional group was significantly larger (30 vs. 22 mm, p = 0.001). All tracts were established successfully. Despite larger stones, the conventional group had significantly longer operative times (145 vs. 108 min, p = 0.001). No significant difference was observed in stone-free rates (55% vs. 57%). The extraplanar group showed significantly lower postoperative serum creatinine levels (80 vs. 87 μmol/L, p = 0.03) and shorter hospital stays (8 vs. 10 days, p = 0.01). Postoperative fever occurred in four patients in the extraplanar group (8% vs. 0%, p = 0.07).</p><p><strong>Conclusions: </strong>Multi-tract PCNL performed under extraplanar USG guidance is safe and efficacious for CRS management. The technique optimizes the puncture strategy, offering superior operative efficiency and potential nephron preservation despite baseline stone load differences.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"6 ","pages":"1713534"},"PeriodicalIF":1.7,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12920187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-risk biochemical recurrence in prostate cancer: identification and early intervention strategies.","authors":"Ahmed Hassan Abdelaziz, Mai Mohamed Ali Ezz El Din, Emad Hamada, Mohamed Abdullah, Hassan Sayed Shaker, M Sherif Mourad, Tarek Osman, Amr Mohamed Nowier, Dina Salah Gad","doi":"10.3389/fruro.2026.1719136","DOIUrl":"10.3389/fruro.2026.1719136","url":null,"abstract":"<p><strong>Purpose: </strong>Biochemical recurrence (BCR) following primary therapy for prostate cancer (PCa) is associated with disease progression; thus, identifying patients at high risk and implementing management strategies remains critical. This expert opinion outlines a set of recommendations for identifying high-risk BCR patients, provides insights into the impact of a multidisciplinary team (MDT) approach on disease management, explores associated costs and resource utilization, and examines the role of androgen receptor signaling pathway inhibitors (ARPIs) in optimizing outcomes.</p><p><strong>Methods: </strong>The latest evidence and clinical guidelines on risk stratification, diagnostic tools, and collaborative management strategies were evaluated. Additionally, expert opinions were collected from nine oncology and urology experts, and their insights were integrated to form a comprehensive approach tailored for clinical application.</p><p><strong>Results: </strong>The panelists reached agreement on several proposed questions, including patients' early detection, risk stratification, early management, and the role of ARPIs and androgen deprivation therapies (ADT). The recommendations emphasize the need for standardized identification of high-risk BCR patients, treatment protocols, and early intervention strategies. Additionally, the multidisciplinary approach facilitates personalized treatment planning, leveraging various specialties' expertise, and addresses the complexity of resource utilization and cost management. However, a lack of agreement on other topics was observed, such as optimal timing of intervention and resource allocation strategies.</p><p><strong>Conclusion: </strong>This narrative, evidence-supported expert-opinion review highlights the importance of standardized protocols, multidisciplinary strategies, and the integration of advanced diagnostics and androgen receptor pathway inhibitors to improve patient outcomes. Further research is warranted to refine predictive models, optimize resource allocation, and enhance therapeutic efficacy.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"6 ","pages":"1719136"},"PeriodicalIF":1.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Advances in pharmacological treatments for urogenital disorders.","authors":"Xiaolong Wang, Peng Wang, Qingfeng Yu","doi":"10.3389/fruro.2026.1776078","DOIUrl":"10.3389/fruro.2026.1776078","url":null,"abstract":"","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"6 ","pages":"1776078"},"PeriodicalIF":1.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12893993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing stone treatment: the transformative impact of flexible navigable suction ureteral access sheath (fans) for inferior calyx calculi (<2 cm).","authors":"Xiang Yun Xu, Hong Jian Tu, Qing Hua Luo, Wen Wei, Fan Qi Cheng, Lei Hua Cao","doi":"10.3389/fruro.2025.1695781","DOIUrl":"10.3389/fruro.2025.1695781","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the efficacy, safety, and stone-free rates (SFR) of the application of a flexible navigable suction ureteral access sheath (FANS) in patients undergoing retrograde intrarenal surgery (RIRS) for inferior calyx calculi (<2 cm).</p><p><strong>Methods: </strong>A retrospective analysis of the clinical data of 111 patients who underwent treatment for inferior calyx calculi at Nanchang People's Hospital between January 2023 and October 2024 was performed. Patients undergoing RIRS with laser lithotripsy were evenly distributed into two groups: FANS with continuous flow lithotripsy in ureterorenolithotripsy procedures (F-Group), a conventional sheath in ureterorenolithotripsy procedures (C-Group).</p><p><strong>Results: </strong>A significantly greater stone clearance rate (96.23% vs. 81.03%, p=0.017) and shorter operative time (37.81 ± 6.07 min vs. 46.59 ± 6.36 min, p<0.001) were observed with the F-Group. Basic attributes, including demographics of patients and stone properties, the infundibulo-pelvic angle (IPA), length of hospital stay, and complications, were compared between the groups and found to be approximately the same.ConclusionsFANS significantly improves SFR without increasing postoperative complications or negatively affecting recovery, offering a promising alternative to conventional sheaths in ureterorenolithotripsy procedures for inferior calyx calculi. FANS improves kidney stone surgery outcomes, is feasible and safe for inferior calyx calculi (<2 cm).</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"5 ","pages":"1695781"},"PeriodicalIF":1.1,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lesion detection using artificial intelligence models in MR images of prostate cancer and prostatitis patients and comparison of model performance.","authors":"Muhammed Kaya, Osman Durdag, Merve Solak, Ahmet Coskuncay, Gulen Burakgazi","doi":"10.3389/fruro.2025.1726795","DOIUrl":"10.3389/fruro.2025.1726795","url":null,"abstract":"<p><strong>Aim: </strong>The diagnosis of prostate cancer and prostatitis becomes challenging when using biparametric Magnetic Resonance (MR) images. This research investigates deep learning models to assess their capability for improving diagnostic accuracy and assisting radiologists.</p><p><strong>Methods: </strong>This retrospective study analyzed 153 patients who received histopathological diagnoses of prostate cancer or prostatitis between January 2017 and December 2023. Patients were categorized according to PI-RADS scores, and both T2A and ADC-DWI (Apparent Diffusion Coefficient-Diffusion-Weighted Imaging) sequences were examined. Expert radiologists labeled the images prior to lesion detection with the Faster R-CNN (Faster Region-based Convolutional Neural Network) model. Nine different classification models were trained using normal and augmented datasets to evaluate their performance. Model reliability was further assessed through cross-validation and statistical significance testing.</p><p><strong>Results: </strong>The Faster R-CNN model achieved 96% accuracy (95% CI: 93.2-98.8%) for P5 and 99% accuracy (95% CI: 96.7-100%) for prostatitis in T2A sequences, and 90% accuracy (95% CI: 85.4-94.6%) for P5 and 97% accuracy (95% CI: 93.8-100%) for prostatitis in ADC-DWI sequences. However, the model failed to effectively detect P4 lesions (0% sensitivity in T2A and 30% in ADC-DWI). The model demonstrated comparable performance to expert radiologists, with no significant difference in overall P5 detection (p > 0.05), and Cohen's kappa indicated substantial agreement (κ = 0.86). The classification models achieved up to 97% accuracy with InceptionV3 in T2A sequences and up to 99% accuracy with DenseNet201 in ADC-DWI sequences. To further evaluate discriminative performance, AUROC values were calculated for all classification models. In T2A sequences, AUROC scores were DenseNet201 (0.98), EfficientNetV2L (0.99), InceptionV3 (0.99), MobileNetV2 (0.92), NASNetLarge (0.83), ResNet50 (0.76), VGG16 (0.98), VGG19 (0.97), and Xception (0.96). In ADC-DWI sequences, AUROC values were DenseNet201 (0.99), EfficientNetV2L (0.96), InceptionV3 (0.99), MobileNetV2 (0.82), NASNetLarge (0.90), ResNet50 (0.64), VGG16 (0.96), VGG19 (0.86), and Xception (0.97), reinforcing the superior discriminative ability of DenseNet201 and InceptionV3 across modalities.</p><p><strong>Conclusion: </strong>The deep learning models demonstrated promising diagnostic capabilities, comparable to radiologists, in distinguishing prostatitis and P5 prostate cancer lesions. Overall, the findings suggest that AI-based diagnostic tools hold potential as clinical decision support systems.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"5 ","pages":"1726795"},"PeriodicalIF":1.1,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12861897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic and prognostic landscape of upper urinary tract urothelial carcinoma: an analysis of a national cancer database.","authors":"Beau Hsia, Mark Moroz, Ethan Sipes, Amber Chang, Rania Jundi, Susan Rafie, Peter Silberstein, Abubakar Tauseef","doi":"10.3389/fruro.2025.1647133","DOIUrl":"10.3389/fruro.2025.1647133","url":null,"abstract":"<p><strong>Purpose: </strong>Upper urinary tract urothelial carcinoma (UTUC) is an uncommon malignancy of the urogenital tract with a wide range of clinical outcomes. While prognostic factors for bladder-based UC are established, less is known about tumors in other locations and the impact of socioeconomic disparities. This study uses a large national database to identify key demographic, clinical, and socioeconomic predictors of overall survival in UC patients, focusing on the primary tumor site.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 12,300 patients diagnosed with UC of the kidney and renal pelvis between 2004 and 2020 from the National Cancer Database (NCDB). Multivariable Cox proportional hazards regression was used to analyze the association between overall survival and factors including patient demographics, tumor characteristics, primary tumor site, and socioeconomic status.</p><p><strong>Results: </strong>The cohort was predominantly male (59%) and White (91%), with a mean age of 71 at diagnosis. Multivariable analysis identified several factors significantly associated with survival. Renal pelvis tumors, the most common primary site (84.9%), were associated with significantly improved survival (HR = 0.84; 95% CI: 0.8-0.9; p<0.001). Compared to males, females exhibited a 15% lower hazard of death (HR = 0.85; 95% CI: 0.81-0.90; p<0.001). Factors associated with worse survival included a higher Charlson-Deyo comorbidity score (HR = 1.51; 95% CI: 1.39-1.65; p<0.001) and advanced NCDB tumor stage. Socioeconomically, patients with higher income (HR = 0.82; 95% CI: 0.75-0.90; p<0.001) and private insurance or Medicare (HR = 0.70; 95% CI: 0.57-0.87; p<0.001) had improved survival. Adjuvant chemotherapy was associated with a lower hazard of death (HR = 0.84; 95% CI: 0.75-0.95; p=0.007), whereas primary radiation therapy was associated with a higher hazard of death (HR = 1.69; 95% CI: 1.54-1.86; p<0.001).</p><p><strong>Conclusion: </strong>This large-scale analysis identifies the primary tumor site as a key prognostic factor in UC, with renal pelvis tumors demonstrating more favorable survival. The study also confirms the significant influence of comorbidity and tumor stage while uniquely highlighting that socioeconomic factors, such as income and insurance, are powerful predictors of outcome. These findings underscore the need for optimized, site-specific treatment strategies and concerted efforts to address healthcare inequities in the management of upper tract UC.</p>","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"5 ","pages":"1647133"},"PeriodicalIF":1.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}