Advances in Urology最新文献

{"title":"Neurotoxicity of Broad-Spectrum Antibiotics in Urinary Tract Infections: Mechanisms and Clinical Implications.","authors":"Lama Hachem, Batoul Darwish, Maram Chaaban, Rawan Khadra, Hashem Shehade, Antoine Abou Fayyad, Hisham F Bahmad, Georges Daoud, Wassim Abou-Kheir","doi":"10.1155/aiu/1858698","DOIUrl":"10.1155/aiu/1858698","url":null,"abstract":"<p><p>Urinary tract infections (UTIs) remain among the most common bacterial infections worldwide, affecting millions every year. While <i>Escherichia coli</i> (<i>E</i>. <i>coli</i>) is the predominant pathogen, a broad range of Gram-negative and Gram-positive organisms can be implicated. Treating UTIs, particularly complicated or severe infections, frequently relies on broad-spectrum antibiotics, often started empirically before identifying the causative pathogen. However, despite their ability to cover a wide spectrum of pathogens, they have become a growing threat to public health, mainly due to the rise of antimicrobial resistance, but also due to the many other adverse effects they can potentially cause. Neurotoxicity represents one of the most consequential yet underrecognized complications of antibiotic therapy. Broad-spectrum agents commonly used for UTIs, including fosfomycin, fluoroquinolones, carbapenems, and cephalosporins, have been associated with a wide range of neurologic manifestations such as epileptic seizures, encephalopathy, movement disorders, delirium, and psychosis, varying in onset, duration, severity, and reversibility. To induce such reactions, antibiotics interact with the central nervous system (CNS) in several ways that can threaten its integrity and disrupt homeostatic control of its components. This review provides a synopsis of the known neurological adverse reactions linked to four major antibiotic classes routinely used in UTI management and the mechanistic pathways underlying CNS toxicity. An overall clearer understanding of these risks may help clinicians balance therapeutic benefit against potential harm, optimize antimicrobial selection, and improve prevention and management strategies for antibiotic-associated neurotoxicity.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"1858698"},"PeriodicalIF":0.6,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214811","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":"Unveiling the Potential of Fish Swim Bladder-Derived Biomaterials in Urological Care.","authors":"Johannes Cansius Prihadi, Havian Daulung Telium, Pradipta Auwrel Putra, Alvin Chandra","doi":"10.1155/aiu/7996782","DOIUrl":"https://doi.org/10.1155/aiu/7996782","url":null,"abstract":"<p><p>Fish swim bladder (FSB)-derived biomaterials have recently emerged as a promising marine-based extracellular matrix (ECM) platform with potential applications in urological tissue engineering and regenerative medicine. This narrative review synthesizes current evidence regarding the structural, biological, and functional properties of FSB and evaluates its potential role in urological reconstruction. This narrative review was conducted using the PubMed, Google Scholar, and ScienceDirect databases with predefined keywords related to FSB-derived biomaterials. Articles published from January 1, 2000, to December 31, 2025, were included. Eligible studies comprised original research, in vitro and in vivo experimental studies, and review articles. FSB is characterized by a high content of type I collagen, elastin, and glycosaminoglycans (GAGs), forming a well-organized, hydrated, and mechanically resilient matrix that closely resembles native mammalian ECM. These properties support cellular adhesion, proliferation, and tissue regeneration, while also modulating inflammatory responses during wound healing. Preclinical studies demonstrate that decellularized FSB scaffolds exhibit favorable mechanical properties, biocompatibility, and the ability to promote constructive tissue remodeling. In addition, hydrolyzed derivatives, such as gelatin and collagen peptides, have demonstrated antioxidant and regenerative properties. However, intrinsic antimicrobial activity remains limited, often requiring additional functionalization to achieve clinically relevant antibacterial effects. Safety considerations, including potential allergenicity, variability in raw materials, and the risk of microbial contamination, underscore the importance of standardized processing and rigorous sterilization protocols. Composition, thermal stability, and gelation behavior vary substantially across fish species, indicating that species selection is a critical determinant of scaffold performance. Despite encouraging findings in experimental models, clinical translation in urological applications remains limited. Further research focusing on organ-specific applications, long-term safety, and optimized scaffold design is essential. Overall, FSB-derived biomaterials represent a sustainable and versatile platform with significant potential to advance regenerative strategies in urological care.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"7996782"},"PeriodicalIF":0.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178921","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":"Assessing the Level of Prostate Cancer Care in a Low-Resource Setting: Disease Pattern, Current Situation of Care, and the Need for Reform-A Retrospective Observational Study From East Oncology Centre, Sudan.","authors":"Mosab A A Alzubier, Eltahir Ahmed Eltahir, Hind Mohi Aldin Abd Allah, Mutasim Mursi Abubaker, Safia Ibrahim Omer Khalid, Abuzar Awadalla Ibrahim Elkhidir Abdol, Mushrga Alamin Ahmed Daood","doi":"10.1155/aiu/3967008","DOIUrl":"10.1155/aiu/3967008","url":null,"abstract":"<p><strong>Background and aims: </strong>Prostate cancer (PC) is a common male malignancy, and it is often diagnosed at advanced stages, particularly in developing countries, largely due to underdeveloped healthcare systems. Resource-limited care, such as bilateral orchidectomy for symptomatic illness, is an economically feasible therapeutic option that may enhance patient condition and survival in a low-resource situation. This study aims to assess the status of PC care and treatment outcomes in eastern Sudan.</p><p><strong>Methods: </strong>A retrospective hospital-based study was conducted at the East Oncology Centre (EOC), Gadarif State, eastern Sudan, including all patients diagnosed with PC between May 2016 and December 2023. Relevant demographic, clinical, pathological, treatment, and outcome data were retrieved from patients' medical records.</p><p><strong>Results: </strong>A total of 231 patients with PC, with a mean age of 70.9 years (± SD 10), all of whom were Sudanese from different ethnic groups, were included in the study. Most patients (86.6%; <i>n</i> = 200) presented with lower urinary tract symptoms, and only 15.6% had a family history of PC. Most of the patients (62.34%, <i>n</i> = 144) had prostate-specific antigen (PSA) levels ranging from 21 to 100 ng/mL; histopathology revealed adenocarcinoma of the prostate with a Gleason score of 8 or more in 60.6% (<i>n</i> = 140). Bone scan results were positive in 50.2% of cases, and 88.3% (<i>n</i> = 204) received hormonal treatment as the primary modality for cancer control. The mortality data indicate that 24.7% (<i>n</i> = 57) of patients had died.</p><p><strong>Conclusions: </strong>This study highlights the suboptimal care for PC in eastern Sudan, where most patients present with late-stage disease, probably due to resource limitations. Addressing late-stage PC requires opportunistic digital rectal examination screening, targeted PSA testing, and increased awareness. Improved outcomes rely on specialist training, standardised care protocols, and the expansion of radiation facilities.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"3967008"},"PeriodicalIF":0.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975359","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":"Neutropenia in Patients With Castration-Resistant Prostate Cancer Treated Using Cabazitaxel and Prophylactic Administration of Pegfilgrastim.","authors":"Kazuhiko Oshinomi, Shota Kikuchi, Masahiro Kurokawa, Toshiki Mugita, Tatsuki Inoue, Motoki Yamagishi, Yoshihiro Nakagami, Masakazu Nagata, Haruaki Sasaki, Kohzou Fuji, Masashi Morita, Takashi Fukagai","doi":"10.1155/aiu/8111761","DOIUrl":"10.1155/aiu/8111761","url":null,"abstract":"<p><strong>Background and aims: </strong>Cabazitaxel has demonstrated survival benefits in patients with metastatic castration-resistant prostate cancer (CRPC). However, Japanese patients are reported to experience higher rates of hematologic toxicity compared to their Caucasian counterparts. Although primary prophylaxis with pegfilgrastim is now routinely used in clinical practice, febrile neutropenia (FN) may still occur. In this study, we aimed to evaluate the real-world safety of cabazitaxel with universal pegfilgrastim prophylaxis in Japanese patients with CRPC, particularly focusing on FN during the first treatment cycle.</p><p><strong>Methods: </strong>We retrospectively evaluated 86 patients with CRPC who received cabazitaxel at Showa Medical University-affiliated hospitals between 2015 and 2021. Cabazitaxel was administered every 3-4 weeks at doses determined by the treating physicians, generally 20-25 mg/m², with daily oral prednisolone. Pegfilgrastim was administered to all patients at least 24 h after cabazitaxel. Univariate analyses were performed to identify baseline factors associated with FN occurring during the first cycle of cabazitaxel. Exploratory logistic regression analysis was additionally performed for FN occurring during the entire treatment course.</p><p><strong>Results: </strong>Among the 86 patients, FN occurred in 12 patients (14.0%) during the entire treatment course, including 8 events (9.3%) during the first cycle. In univariate analyses, the only factor significantly associated with first-cycle FN was a longer interval from CRPC diagnosis to cabazitaxel initiation (median, 1194.5 vs. 689 days, <i>p</i> = 0.0094). A similar tendency was observed when FN occurrence during the entire treatment course was analyzed. In exploratory logistic regression analysis for FN during the entire treatment course, the same factor showed a consistent trend toward association with FN development.</p><p><strong>Conclusion: </strong>Despite universal pegfilgrastim prophylaxis, approximately 10% of Japanese patients developed FN during the first cycle of cabazitaxel therapy. A longer interval from CRPC diagnosis to cabazitaxel initiation showed a consistent trend toward association with FN risk in Japanese patients across analyses. These findings provide real-world safety data and highlight the importance of careful hematologic monitoring, particularly in patients treated later in the CRPC disease course.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"8111761"},"PeriodicalIF":0.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954701","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":"Klotho G-395A Polymorphism as a Risk Factor for Atrial Fibrillation in Patients on Maintenance Hemodialysis.","authors":"Ying Zhang, Xiangxiang Wang, XiaoXuan Su, Zhixiang Bian, Shunjie Chen","doi":"10.1155/aiu/9179415","DOIUrl":"10.1155/aiu/9179415","url":null,"abstract":"<p><strong>Objective: </strong>To explore the relationship between atrial fibrillation and the Klotho G-395A polymorphism in patients on maintenance hemodialysis (MHD).</p><p><strong>Methods: </strong>The study included 120 MHD patients (persistent atrial fibrillation, <i>n</i> = 30; paroxysmal atrial fibrillation, <i>n</i> = 30; normal sinus rhythm, <i>n</i> = 60) and 120 control individuals. Klotho G-395A mutations were detected by the fluorescence quantitative polymerase chain reaction. ELISA was used to detect serum soluble Klotho (sKl) and intact fibroblast growth factor 23 (iFGF23) levels, and left atrium diameters were measured by echocardiography. Correlation analysis between Klotho G-395A genotypes, clinical parameters, and biochemical indexes was performed, along with logistic regression analysis to determine the risk factors for atrial fibrillation.</p><p><strong>Results: </strong>Three genotypes of Klotho G-395A, namely, GG, GA, and AA, were detected. The frequencies of the GA/AA genotypes and A allelic genes were significantly higher in the MHD patients than in the healthy controls, and these genotypes were associated with both atrial fibrillation and persistent atrial fibrillation. Furthermore, serum sKl, serum iFGF23, and left artery diameter were significantly associated with atrial fibrillation and also showed significant differences between the persistent and paroxysmal atrial fibrillation groups. The serum sKl level was negatively correlated with serum FGF23 level and the left atrium diameter, while the serum FGF23 level was positively correlated with the left atrium diameter. The incidence of atrial fibrillation and left atrium diameter was significantly higher in those with the GA/AA genotype than in those with the GG genotype, while the serum sKl levels were significantly lower. The GA/AA genotype was associated with a 5.444 times higher likelihood of atrial fibrillation than the GG genotype.</p><p><strong>Conclusions: </strong>The A allele of Klotho G-395A may be a risk marker of atrial fibrillation in MHD patients. Moreover, sKl deficiency may contribute to the early development of atrial fibrillation in MHD patients.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"9179415"},"PeriodicalIF":0.6,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904996","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":"Association Between Prostate Morphology and Intraoperative Blood Loss During Transurethral Resection of the Prostate: A Prospective Observational Study.","authors":"Yutong Lu, Guiling Wang, Jiangtao Bai, Haitao Jia, Enguang Yang, Xiangbin Kong, Qihui Zheng, Zhiping Wang","doi":"10.1155/aiu/6829187","DOIUrl":"10.1155/aiu/6829187","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between prostate morphology and intraoperative blood loss during TURP.</p><p><strong>Materials and methods: </strong>This prospective observational study included 1120 patients undergoing TURP. Intraoperative blood loss was quantitatively assessed using an endoscopic surgical monitoring system. The transverse and longitudinal diameters of the prostate were measured preoperatively by ultrasonography, and the W/L ratio was defined as the transverse-to-longitudinal diameter ratio. Univariable and multivariable linear regression analyses, nested regression models, and ROC analysis were used to evaluate the association between the W/L ratio and intraoperative blood loss.</p><p><strong>Results: </strong>The median intraoperative blood loss was 104 mL (IQR 36-214), and the median W/L ratio was 1.06 (IQR 1.02-1.18). Univariable analysis showed that the W/L ratio was negatively associated with intraoperative blood loss. In the multivariable analysis, after adjustment for age, BMI, prostate volume, operative time, <i>Q</i> _max, 5-ARI use, and surgeon experience category, the W/L ratio remained independently associated with intraoperative blood loss (<i>B</i> = - 45.957, 95% CI: -89.229 to -2.684, <i>p</i> = 0.037). Nested regression models showed that the addition of the W/L ratio increased the model <i>R</i> ² from 0.444 to 0.446, indicating statistically significant but limited incremental information. Exploratory ROC analyses yielded AUCs of 0.816 and 0.791 for intraoperative blood loss thresholds of ≥ 300 mL and ≥ 400 mL.</p><p><strong>Conclusions: </strong>A lower prostate W/L ratio was independently associated with greater intraoperative blood loss during TURP. Although its effect size was smaller than those of operative time and prostate volume, the W/L ratio may serve as an adjunctive morphometric marker that is readily available from preoperative imaging. <b>Trial Registration:</b> Chinese Registry of Clinical Trial: ChiCTR2400088743.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"6829187"},"PeriodicalIF":0.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849491","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":"Renal Cell Carcinoma Texture Analysis With the KiTS23 Dataset: A Retrospective Study.","authors":"Yuan Liang, Abraham G Campbell, Sourav Bhattacharjee","doi":"10.1155/aiu/5082571","DOIUrl":"10.1155/aiu/5082571","url":null,"abstract":"<p><strong>Background and aims: </strong>Computed tomography texture analysis, powered by machine learning techniques, may differentiate clear cell renal cell carcinoma (ccRCC) from other renal tumor subtypes, such as papillary and chromophobe variants, or benign renal masses such as oncocytomas, as demonstrated here using the KiTS23 dataset.</p><p><strong>Methods: </strong>After excluding multifocal cases to avoid lesion-level labeling ambiguity and intrapatient lesion heterogeneity, 396 cases were included. Using PyRadiomics, 386 radiomics features were initially extracted from preprocessed computed tomography volumes and tumor segmentation masks. Subsequent multistage feature selection reduced the candidate feature set to 73 radiomics descriptors, and LASSO further selected six features for the primary classifier. Candidate machine-learning models were evaluated, with class-weighted Logistic Regression selected as the primary model. Threshold adjustment using the Youden index and bootstrap feature-selection stability analysis were performed.</p><p><strong>Results: </strong>The LASSO-selected class-weighted Logistic Regression model showed the best overall performance. Using the default probability threshold of 0.5, it achieved an accuracy of 76.5%, an area under the receiver operating characteristic curve of 80.4%, a precision of 91.2%, a sensitivity of 73.8%, and a specificity of 82.9% on the held-out test set. Youden-index thresholding increased sensitivity but reduced specificity; therefore, the fixed threshold of 0.5 was retained as the primary operating threshold. Bootstrap stability analysis showed that several LASSO-selected radiomics descriptors were repeatedly selected across resampled training cohorts.</p><p><strong>Conclusions: </strong>Radiomics-based machine learning shows promise for discriminating ccRCC from non-ccRCC renal tumors, but the results remain preliminary and have been evaluated internally. Given the moderate discrimination and lack of external validation, further studies using larger, multicenter datasets with standardized radiomics workflows are necessary.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"5082571"},"PeriodicalIF":0.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786965","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":"Clinical Significance of Pathological Lymph Node Status in Prostate Cancer Patients Undergoing Radical Prostatectomy: A 25-Year Institutional Cohort Study.","authors":"Tomoyuki Shimabukuro, Chietaka Ohmi, Koji Shiraishi","doi":"10.1155/aiu/1399937","DOIUrl":"10.1155/aiu/1399937","url":null,"abstract":"<p><strong>Background: </strong>While the therapeutic value of pelvic lymph node dissection (PLND) remains controversial, the pathological lymph node status itself may provide important prognostic information after radical prostatectomy (RP).</p><p><strong>Methods: </strong>Among 610 consecutive patients who underwent RP between January 2000 and December 2019, with follow-up through December 2024, we retrospectively analyzed 445 patients with intermediate- or high-risk disease according to the D'Amico classification who underwent PLND. Patients were stratified according to the pathological lymph node status into pN0 (<i>n</i> = 416) and pN1 (<i>n</i> = 29) groups. The primary endpoint was overall survival (OS), and secondary endpoints included biochemical recurrence (BCR) and the prognostic significance of pathological lymph node status.</p><p><strong>Results: </strong>The median age of the cohort was 68 years. BCR occurred in 26% of the pN0 patients, with a median time to BCR of 29 months, and in 41% of pN1 patients, with a median time to BCR of 47 months. During follow-up, 38 all-cause deaths (9.1%) occurred in the pN0 group and 9 (31.0%) in the pN1 group. Kaplan-Meier analysis showed no significant difference in BCR-free survival between groups, whereas OS was significantly worse in the pN1 group (hazard ratio: 2.768; 95% confidence interval: 1.315-5.829; <i>p</i> = 0.007). Ten-year OS rates were 94% for pN0 patients and 74% for pN1 patients. Multivariable analysis identified the pN1 status and postoperative Gleason score of 7 as independent prognostic factors for OS.</p><p><strong>Conclusions: </strong>Pathological lymph node positivity is a strong independent predictor of inferior OS in patients undergoing RP for localized prostate cancer. These findings underscore the need for tailored postoperative management strategies in patients with node-positive disease.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"1399937"},"PeriodicalIF":0.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13482764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786727","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":"Clinical Characteristics, Long-Term Outcomes, and Prognostic Factors in High-and Very High-Risk Prostate Cancer: A 25-Year Institutional Cohort Study.","authors":"Tomoyuki Shimabukuro, Hidekazu Tanaka, Masahiro Tanabe, Takanori Tokunaga, Kosuke Shimizu, Nakanori Fujii, Keita Kobayashi, Toshiya Hiroyoshi, Hiroshi Hirata, Koji Shiraishi","doi":"10.1155/aiu/9913238","DOIUrl":"10.1155/aiu/9913238","url":null,"abstract":"<p><strong>Background and objective: </strong>High- and very high-risk prostate cancer (hvPCa) is associated with substantial prostate cancer-specific mortality, making optimal treatment selection challenging. This study reevaluated our 25-year institutional experience with hvPCa to assess long-term oncological outcomes and identify prognostic factors associated with survival.</p><p><strong>Methods: </strong>We retrospectively analyzed 220 patients with hvPCa reclassified according to the latest National Comprehensive Cancer Network guidelines. Of these, 66 underwent radical prostatectomy (RP), 52 received radiotherapy plus androgen deprivation therapy (RT + ADT), and 102 received primary ADT. Long-term oncological outcomes were compared across treatment modalities and risk groups. Prognostic factors associated with prostate cancer-specific survival (PCSS) were evaluated using Cox proportional hazards models.</p><p><strong>Results: </strong>The median age was 71 years, and the median follow-up duration was 88 months. During follow-up, 49 patients (22.3%) died from any cause, and 19 (8.6%) died from prostate cancer. Among high-risk patients, overall survival was significantly better in the RP group than in the ADT group (hazard ratio [HR]: 4.812; 95% confidence interval [CI]: 1.832-12.635; <i>p</i> = 0.001). Among very high-risk patients, PCSS was significantly worse in the ADT group than in the RP group (HR: 2.899; 95% CI: 1.454-5.782; <i>p</i> = 0.003). Multivariable analysis identified ECOG performance status ≥ 2 (HR: 40.756; 95% CI: 1.846-899.767; <i>p</i> = 0.019) and biochemical recurrence (HR: 21.566; 95% CI: 1.079-430.937; <i>p</i> = 0.044) as independent predictors of poorer PCSS.</p><p><strong>Conclusions: </strong>Poorer ECOG performance status and biochemical recurrence were independently associated with worse PCSS in patients with hvPCa. These findings highlight the prognostic importance of patient functional status in addition to conventional tumor-related factors and may contribute to improved risk stratification and individualized treatment selection.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"9913238"},"PeriodicalIF":0.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13482177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786682","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":"Holmium: YAG Popcorn Lithotripsy-In Vitro Comparison of Settings and MOSES Across Stone Densities.","authors":"Oleksandr Chepeliuk, Asaf Shvero, Rinat Lasmanovich, Lopez Isaias Caballero, Dina Orkin, A Zohar Dotan, E Dorit Zilberman, Nir Kleinmann","doi":"10.1155/aiu/3584394","DOIUrl":"10.1155/aiu/3584394","url":null,"abstract":"<p><strong>Purpose: </strong>To compare Holmium: YAG laser settings for popcorn lithotripsy and evaluate the impact of MOSES modulation across stone-density groups.</p><p><strong>Materials and methods: </strong>An in vitro bench model was used with synthetic gypsum stones prepared at three density levels (low, intermediate, and high: mean attenuation was 574, 945, and 2067 HU, respectively). For each trial, five fragments (2.8-3.3 mm) were treated using popcorn technique with Holmium: YAG laser and 272 µm fiber during a 2 min run under standardized irrigation. Five laser settings (0.3 J/80 Hz, 0.5 J/40 Hz, 1.0 J/20 Hz, 1.0 J/30 Hz, and 1.5 J/20 Hz) were tested with and without MOSES mode: each setting-by-modulation condition was repeated six times. The primary endpoint was percent mass reduction; secondary endpoints were residual fragment counts 1-2 and > 2 mm. Results are presented as mean ± SD, and ANOVA was used for comparison.</p><p><strong>Results: </strong>In the low-density group, percent mass reduction was highest overall (65%-86%), with 1.0 J/30 Hz achieving the greatest reduction, MOSES provided no additional benefit (<i>p</i> = 0.6). In the intermediate-density group, the greatest mass reduction was achieved with 1.0 J/30 Hz with MOSES (51% ± 5.9%), and MOSES effects were setting-dependent, and at 1.0 J/30 Hz MOSES reduced total residual fragments (5.3 vs 8.0, <i>p</i> = 0.04). In the high-density group, 1.0 J/30 Hz with MOSES achieved the highest mass reduction (71.5% ± 12.1%) and was associated with improved outcomes (<i>p</i> = 0.037). Secondary analyses of residual fragments generally paralleled these findings.</p><p><strong>Conclusions: </strong>In this in vitro popcorn lithotripsy model, 1.0 J/30 Hz provided the most consistent performance across density groups. MOSES modulation did not improve outcomes in low-density stones but was associated with improved efficiency in intermediate- and high-density stones.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2026 ","pages":"3584394"},"PeriodicalIF":0.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760437","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}