BMC Urology最新文献

{"title":"Early systemic inflammatory indices and postoperative SIRS after percutaneous nephrolithotomy under spinal versus general anaesthesia: a prospective cohort study.","authors":"Sait Fatih Öner, Sevim Şenol Karataş, Oğuz Kağan Bulut, Kadir Yıldırım","doi":"10.1186/s12894-026-02368-y","DOIUrl":"10.1186/s12894-026-02368-y","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous nephrolithotomy (PCNL) may induce an early systemic inflammatory response. This study compared perioperative changes in systemic inflammatory indices between patients undergoing elective PCNL under spinal or general anaesthesia and explored the relationship of these indices with postoperative systemic inflammatory response syndrome (SIRS).</p><p><strong>Materials and methods: </strong>This single-centre, prospective, non-randomised observational cohort study included consecutive adult patients undergoing elective PCNL between November 2025 and June 2026. Anaesthetic technique was determined as part of routine clinical care, and patients were classified according to the technique received. The primary outcome was the between-group comparison of perioperative changes in the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), measured preoperatively and 6 h postoperatively. Secondary clinical outcomes were postoperative SIRS, fever, and length of hospital stay. Receiver operating characteristic analysis, decision curve analysis, and a parsimonious two-variable logistic regression analysis involving SIRS were performed as exploratory secondary analyses.</p><p><strong>Results: </strong>A total of 150 patients were included in the final analysis, with 75 patients in each anaesthesia group. Preoperative inflammatory indices were similar between the groups, whereas postoperative NLR, SII, SIRI, and AISI values and their corresponding Δ values were significantly higher in the general anaesthesia group (all p < 0.001). Postoperative SIRS occurred in 5 patients (6.7%) in the spinal anaesthesia group and 16 patients (21.3%) in the general anaesthesia group (p = 0.017), while postoperative fever occurred in 10.7% and 24.0%, respectively (p = 0.031). Length of hospital stay did not differ significantly between groups. Among the evaluated inflammatory indices, ΔAISI showed the highest discriminatory performance for postoperative SIRS (AUC = 0.962, 95% CI: 0.923-0.991). In the exploratory parsimonious multivariable model, general anaesthesia (adjusted OR = 12.02, 95% CI: 1.06-136.68, p = 0.045) and ΔAISI (adjusted OR = 1.51 per 100-unit increase, 95% CI: 1.26-1.81, p < 0.001) were associated with postoperative SIRS after mutual adjustment. The wide confidence interval for general anaesthesia indicates substantial imprecision in the magnitude of this association.</p><p><strong>Conclusion: </strong>General anaesthesia was associated with a more pronounced early postoperative inflammatory response and higher observed rates of SIRS and fever than spinal anaesthesia in this prospective observational cohort. ΔAISI showed the highest discriminatory performance for postoperative SIRS among the evaluated inflammatory indices; however, the SIRS-related analyses were exploratory and based on only 21 events","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative complications of percutaneous nephrolithotomy and combined percutaneous nephrolithotomy with uni‑ and bilateral ureterorenoscopic stone therapy: results of the GRAND study.","authors":"Benedikt Ebner, Paulo L Pfitzinger, Troya Georgieva, Iulia Blajan, Moritz Happe, Yannic Volz, Maria Apfelbeck, Christian G Stief, Michael Chaloupka, Nikolaos Pyrgidis","doi":"10.1186/s12894-026-02357-1","DOIUrl":"10.1186/s12894-026-02357-1","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) is a standard therapy for large renal stones. When combined with unilateral or bilateral ureterorenoscopy, stone-free rates may increase, but data on perioperative complications remain limited.</p><p><strong>Methods: </strong>We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2023). We assessed, through multiple patient-level analyses, perioperative morbidity, mortality, length of hospital stay, intensive care unit admissions, and the evolution of PCNL during the last years in Germany.</p><p><strong>Results: </strong>A total of 110,276 patients underwent PCNL (n = 98,965; 90%) and 11,208 patients (10%) underwent PCNL + unilateral ureterorenoscopy, respectively. The number of patients undergoing PCNL + bilateral ureterorenoscopy was very low (n = 103; 0.1%). Overall mortality was low after PCNL (0.2%) and PCNL + unilateral ureterorenoscopy (0.2%). PCNL + unilateral ureterorenoscopy was associated with increased odds of transfusion (3.3% versus 2.4%, OR: 1.3, p < 0.001), sepsis (2% versus 1.3%, OR: 1.6, p < 0.001), and acute kidney disease (2.6% versus 1.5%, OR: 1.6, p < 0.001) compared to PCNL. ICU admission rates were 1.9% after PCNL and 2.3% after PCNL + unilateral ureterorenoscopy (OR: 1.2, p = 0.004). Median length of hospital stay was 6 and 7 days, respectively.</p><p><strong>Conclusions: </strong>PCNL in Germany over the past two decades was associated with low perioperative morbidity and mortality. While PCNL + unilateral ureterorenoscopy is increasingly performed and is generally safe, it carries a modestly elevated risk profile. PCNL + bilateral ureterorenoscopy, in contrast, remains rarely performed. Prospective collaborative studies are warranted to define the optimal stone management strategies.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive biofeedback-assisted vs. conventional pelvic floor muscle training combined with high-effort resistance training for urinary incontinence after radical prostatectomy: a randomized controlled trial.","authors":"Marko Babović, David Aguayo, Joachim Wiskemann","doi":"10.1186/s12894-026-02333-9","DOIUrl":"10.1186/s12894-026-02333-9","url":null,"abstract":"<p><strong>Background: </strong>Radical prostatectomy (RP) often leads to urinary incontinence (UI). There is sufficient evidence from randomized controlled trials (RCTs) that pelvic floor muscle and sphincter training (PFMT) are effective interventions to reduce UI.</p><p><strong>Objective: </strong>To compare the effects of high-effort resistance training (HERT) combined with a non-invasive biofeedback-assisted device PFMT (dPFMT) versus HERT combined with conventional physiotherapeutic PFMT (pPFMT) on UI in prostate cancer patients undergoing RP.</p><p><strong>Methods: </strong>Men with a history of RP for localized prostate cancer were randomly assigned to dPFMT (n = 55) or pPFMT group (n = 54). Both PFMT intervention groups underwent a 12-week whole body HERT program performed at moderate to high loads (> 60% 1-repetition maximum, performed to momentary failure).</p><p><strong>Measurements: </strong>Urinary leakage was assessed with the 24-hour pad weight test (24-h pad test) at the baseline (T0) and at the end of the 12-week lasting programs (T1). Individual changes of cumulative pad weight in gram (g) from T0 to T1 were calculated and compared between groups. An UI reduction of ≥ 50% was considered as treatment success and compared between groups (primary endpoint).</p><p><strong>Results: </strong>Ninety-six participants (88%) completed the intervention. All participants demonstrated a statistically significant reduction in 24-h pad test values from T0 to T1 (Mean (SD): -86.39 g (336.25 g); 𝑝 < 0.001). Treatment success did not differ between groups (OR = 1.19, 95% CI 0.53-2.66; 𝑝 = 0.670) and was achieved by 52.1% of all participants. In a post hoc exploratory analysis restricted to participants achieving treatment success, the relative reduction in urinary leakage from T0 to T1 was greater in the dPFMT group than in the pPFMT group (mean (SD) = -83.97% (13.88%) vs. -74.68% (12.93%); 𝑝 = 0.017). This exploratory finding should be interpreted with caution, particularly because no adjustment for multiple testing was applied. Time since surgery was a significant negative predictor of treatment success (p < 0.001), whereas age (p = 0.313) and follow-up rehabilitation treatment (AHB; p = 0.994) were not. None of the examined variables predicted the magnitude of change in urinary leakage.</p><p><strong>Conclusion: </strong>Both device-based and physiotherapist-guided PFMT were associated with significant reductions in objectively measured urinary leakage after RP. No statistically significant between-group differences were observed under conditions evaluated in this study.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT06206993, retrospectively registered on 15 December 2023.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reusable vs single-use flexible cystoscopes in outpatient urology: a real-world micro-costing and user evaluation.","authors":"Felix Seelemeyer, Rouvier Al-Monajjed, Jan Philipp Radtke, Stephan Nüesch, Jan Herden, Sassan Nazari, Ruben Gößmann","doi":"10.1186/s12894-026-02284-1","DOIUrl":"10.1186/s12894-026-02284-1","url":null,"abstract":"<p><strong>Background and objective: </strong>Flexible cystoscopy is integral to outpatient urology, particularly for surveillance of non-muscle-invasive bladder cancer. Real-world economic data comparing reusable (RU) and single-use (SU) cystoscopes in German outpatient practice are scarce. We evaluated procedure-level costs and multidisciplinary user perceptions under routine conditions.</p><p><strong>Methods: </strong>A micro-costing analysis was performed in a German outpatient urology centre (337 cystoscopies/year). Capital investment (5-year amortisation), maintenance, reprocessing, consumables, and labour were included. Baseline and full-equipment replacement scenarios were modelled, and break-even thresholds calculated. A standardised survey of 13 physicians and 25 nursing staff from five practices assessed technical performance and workflow domains (5-point Likert scale). Groups were compared using Mann-Whitney U tests with Cliff's delta.</p><p><strong>Results: </strong>Mean per-procedure cost was €27.25 for RU and €179.00 for SU. RU became cost-effective beyond 67 procedures annually; this threshold increased to 265 procedures when modelling full equipment renewal (€43,050). Physicians rated RU superior for manoeuvrability (p = 0.02) and SU superior for logistics (p = 0.02), with no differences in image quality, ergonomics, diagnostic confidence, or overall impression. Nursing staff favoured SU across all domains (all p < 0.001), particularly reprocessing workload and reliability. Limitations include single-centre design, evaluation of one device per category, context-specific reimbursement structures, and absence of primary environmental or patient-reported outcomes.</p><p><strong>Conclusions: </strong>In high-volume outpatient settings, RU cystoscopes are economically advantageous. However, SU devices offer substantial workflow benefits. Device selection should be context-specific, integrating case volume, infrastructure, and multidisciplinary perspectives.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13418758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A deep learning approach for predicting antimicrobial resistance in urinary tract infections.","authors":"Marian Shaker, Adel Zaki, Sara Lofty Asser, Iman El Sayed, Mohamed Moustafa Azmy","doi":"10.1186/s12894-026-02203-4","DOIUrl":"https://doi.org/10.1186/s12894-026-02203-4","url":null,"abstract":"<p><strong>Background: </strong>Drug resistance is a crucial issue in patients with urinary tract infection (UTI). This study aimed to detect drug-resistant (DR) UTI cases using suitable machine learning classifiers for early prediction of DR UTI.</p><p><strong>Methods: </strong>Three databases were used. The first database was from UTI patients at Alexandria University Hospital in Egypt. The second database was from a general clinic in Northern Mindanao, Philippines. The third was from Al-Rafa Laboratory, IBB University, IBB City, Yemen. Novel mathematical methods were compared for the detection of DR UTI patients in database 1, positive UTI patients or not in database 2, and multi-drug resistance (MDR) or not in database 3. These methods were compared to extract features from the used databases based on novel engineering calculation methods. After that, several classifiers were compared using these features to determine whether the UTI patients were DR to the antibiotics or not. The classifier used was based on a deep learning method, which was known as bidirectional long short-term memory (BILSTM). The logistic regression and gradient boosting classifiers were also compared. Each database was classified based on holdout or K-fold cross-validation methods.</p><p><strong>Results: </strong>The selected approach for extracting values of the UTI patients was based on the fractional discrete cosine decomposition method (FrdcDM). The obtained accuracy rate and the area under the curve (AUC) of this method were the highest when it was applied to the three databases, based on hold-out and K-fold cross-validation methods, using deep learning. For example, the accuracy rate and AUC after applying this method on database 1, using deep learning as a classification method based on the holdout validation method, were 97.4% and 95%, respectively. If the same model was applied to database 2, the accuracy and the AUC rates were 99.1% and 99.5%, respectively. The accuracy and AUC rates after applying the method for database 3 were 98.2%, 98.6%, respectively, based on the deep learning of the holdout cross-validation method. The classification parameter rates of the deep learning were the highest compared with the other classifiers, such as logistic regression and gradient boosting, especially using databases 1 and 2.</p><p><strong>Conclusion: </strong>The classification parameters of the selected method were the highest compared to other methods. Therefore, this method could be used to detect DR UTI in patients. This model showed potential for assisting in DR prediction. Therefore, physicians are helped to choose the right plan and improve patient health.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing flexible and navigable ureteral access sheaths (FANS) manoeuvrability: the impact of sheath size, working channel occupancy and deflection technique - an EAU endourology in vitro analysis.","authors":"Steffi Kar Kei Yuen, Vineet Gauhar, Alex Qinyang Liu, Ivan Ching Ho Ko, Yuen Hei Chung, Jia-Lun Kwok, Chi-Ho Leung, David Ka-Wai Leung, Francis Chun Him Wong, Joseph Kai Man Li, Hoi Chak Chan, Yi Quan Tan, Arman Tsaturyan, Bhaskar Somani, Chi-Fai Ng","doi":"10.1186/s12894-026-02281-4","DOIUrl":"10.1186/s12894-026-02281-4","url":null,"abstract":"<p><strong>Introduction: </strong>Conventional ureteral access sheaths are placed below the ureteropelvic junction (UPJ), whereas the novel flexible and navigable suction ureteral access sheaths (FANS) are navigated across the UPJ with its distal tip deflected into target calyx under endoscopic guidance to facilitate stone fragments suctioning. We evaluate how FANS deflection angles are affected by sheath sizes, occupancy of working channel (WC) (empty, occupied by Olympus Soltive™ Thulium Laser Fiber 150 μm and 200 μm core diameter) and deflection techniques (ureteroscope deflection versus sheath advancement) across four brands of FANS.</p><p><strong>Materials & methods: </strong>In-vitro deflection angles of brand new FANS (sheath sizes 10/12Fr, 11/13Fr and 12/14Fr) ClearPetra (Well Lead Medical Co., Ltd, China) 46 cm, Elephant II (YiGao Medical Technology Co., Ltd, China) 50 cm, Innovex (Innovex Medical Co., Ltd, Shanghai, China) 50 cm, and Reborn (Hunan Reborn Medical Science and Technology Development Co., Ltd, China) 50 cm with brand new single-use flexible ureteroscope Pusen Uscope 7.5Fr PU3033A (Zhuhai Pusen Medical Technology Co., Ltd. Guangzhou, China) were measured in triplicate with varied WC occupancy and forementioned techniques. Maximum deflection angle was expressed as a mean of 3 measurements. One-way ANOVA test was performed for comparisons of the effect of sheath sizes, sheath brands, working channel occupancy, and different deflection techniques. Four-way ANOVA test was performed to evaluate the influence of the aforementioned four factors on the maximal deflection angle, with analysis on the main effects and interaction. For all tests, a two-sided p-value less than 0.05 was considered statistically significant. Statistical tests were performed with SPSS version 26.0 (IBM Corp., Armonk, NY, USA).</p><p><strong>Results: </strong>10/12Fr and 11/13Fr sheath sizes have significantly better deflection angles than 12/14Fr across all brands with a 7.5Fr flexible ureteroscope. Sheath advancement technique was significantly better with ureteroscope deflection technique. There is no significant difference in deflection angles with occupancy of 150-200 μm fiber.</p><p><strong>Conclusion: </strong>Gaining better understanding of the performance of FANS can ultimately guide clinicians in their selection and optimal utilization of the instrument to enhance procedural efficacy and treatment outcomes.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative discovery of bladder herniation in a known inguinoscrotal hernia during open cystolithotomy, prostatectomy and hernioraphy : a case report and review of diagnostic pitfalls.","authors":"Hassami Sawadogo, Abdoul-Karim Paré, Abdoul-Karim Ouattara, Fatao Ouédraogo, Békaye Ouédraogo, Tiéoulé Mamadou Traoré, Clotaire Alexis Marie Kiemdiba Donega Yaméogo, Brahima Kirakoya, Adama Ouattara","doi":"10.1186/s12894-026-02269-0","DOIUrl":"https://doi.org/10.1186/s12894-026-02269-0","url":null,"abstract":"<p><strong>Background: </strong>Inguinoscrotal herniation of the urinary bladder (ISHB) is a rare but underdiagnosed condition, accounting for 1-4% of inguinal hernias and discovered intraoperatively in more than 80% of cases. Recognised predisposing factors include advanced age, obesity, and chronic infravesical obstruction, of which benign prostatic hyperplasia (BPH) is the most common. Failure to identify ISHB preoperatively exposes the surgeon to the risk of inadvertent vesical injury, reported in up to 12% of unprepared herniorrhaphies.</p><p><strong>Case presentation: </strong>A 61-year-old man was admitted for obstructive lower urinary tract symptoms complicated by chronic urinary retention, in association with a right inguinoscrotal swelling. Ultrasonography demonstrated a 145 g prostatic enlargement and a 43 × 27 mm vesical calculus. A combined procedure was planned: transvesical open cystolithotomy, prostatectomy, and inguinoscrotal hernia repair. During inguinal dissection, the absence of a true peritoneal sac prompted meticulous exploration, which identified the bladder as the hernial content. The bladder was safely reduced into the pelvic cavity without iatrogenic injury, and a Bassini herniorrhaphy was performed. The postoperative course was uneventful. At 10 months, the patient reported marked voiding improvement, with a maximum urinary flow rate of 18 mL/s.</p><p><strong>Conclusions: </strong>In male patients aged over 50 years presenting with an inguinal hernia in the setting of BPH, LUTS, or vesical calculus, selective preoperative imaging (CT or cystography) should be considered when clinical examination or risk factor profiling raises suspicion of bladder herniation. When the diagnosis is not established preoperatively, meticulous intraoperative dissection remains the cornerstone of safe herniorrhaphy and the principal safeguard against iatrogenic vesical injury. Simultaneous management of ISHB and coexisting urological conditions is feasible and advantageous, particularly in resource-limited settings.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake of prostate biopsy and its associated factors among patients previously confirmed to have elevated prostate-specific antigen levels at Kyabirwa surgical center, Jinja city: a cross-sectional study.","authors":"Elton George Wandira, Peninnah Asiimwe, Job Nanyiri, Annah Tinka Ainembabazi, Binoga Bakaleke Moses, Ambrose Nuwahereza, Arthur Emoru, Joseph Okello Damoi, Anna Turumanya Kalumuna, Michael L Marin","doi":"10.1186/s12894-026-02262-7","DOIUrl":"10.1186/s12894-026-02262-7","url":null,"abstract":"<p><strong>Purpose: </strong>To assess prostate biopsy uptake and its associated factors among patients previously found to have elevated Prostate-Specific Antigen results at the Kyabirwa Surgical Center (KSC).</p><p><strong>Method: </strong>An analytical cross-sectional design was employed to study 52 male patients with elevated PSA levels (> 10 ng/mL) at the Kyabirwa Surgical Center. They were consecutively sampled, located in their areas of residence, and engaged in structured interviews. Data were collected and analyzed descriptively using SPSS version 26, with a log-binomial model for relationship analysis.</p><p><strong>Results: </strong>The proportion of patients with elevated PSA levels at the KSC who underwent prostate biopsy was 55.8%, with most having their biopsies performed at the center (72.4%). Perceived good health status (aPR = 0.368¸95% CI = 0.155-0.877, p = 0.024) lowered the prevalence of uptake. However, educating patients about prostate health KSC (aPR = 2.150, 95% CI = 1.157-3.995, p = 0.015), the cost of a prostate biopsy (aPR = 2.647, 95% CI = 1.374-5.099, p = 0.004), the meaning of PSA results (aPR = 2.647, 95% CI = 1.374-5.099, p = 0.004), the importance of a biopsy, how it is performed (aPR = 2.078, 95% CI = 1.137-3.798, p = 0.016), and being followed up by healthcare workers at KSC to determine compliance with the instructions to perform a biopsy (aPR = 1.603, 95% CI = 1.074-2.394, p = 0.021) were associated with a higher prevalence of biopsy uptake.</p><p><strong>Conclusion: </strong>Only half of the patients who have elevated Prostate-Specific Antigen levels at the Kyabirwa Surgical Center and are advised to have a prostate biopsy done, go ahead and undergo biopsy. Only a few of them still have the biopsy done at other facilities, further emphasizing the fact that prostate cancer screening behavior is poor among men who are urged to undergo screening via biopsy by the KSC staff. The negative factors associated with prostate biopsy uptake are patient-related, while all positive factors associated with biopsy uptake are institutional and specifically related to post-test patient education.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond traditional nephrometry: a 3D quantitative framework for predicting pentafecta and evaluating mediation effects in nephron-sparing surgery.","authors":"Jia Li, Zhenting Zhang, Chunsen Yang, Rui Lin, Chao Zhang, Wenfeng Liao, Kun Wang, Sanxiang Li, Xin Yao","doi":"10.1186/s12894-026-02268-1","DOIUrl":"10.1186/s12894-026-02268-1","url":null,"abstract":"<p><strong>Purpose: </strong>To establish a three-dimensional (3D) quantitative framework for predicting pentafecta achievement and to explore the underlying compensatory associations in nephron-sparing surgery (NSS).</p><p><strong>Methods: </strong>We retrospectively analyzed 375 patients undergoing NSS. Preoperative 3D morphometric metrics-specifically contact surface area (CSA) and retained blood-perfused renal volume (RBRV)-were extracted. Pentafecta was strictly defined by optimal perioperative success and 1-year functional preservation (eGFR loss < 10% without chronic kidney disease upstaging). Multivariable logistic regression, quadrant-based phenotypic analysis, and serial mediation modeling were performed to compare predictive performance and explore potential sequential clinical pathways.</p><p><strong>Results: </strong>Pentafecta was achieved in 203 patients (54.1%). The 3D quantitative framework, incorporating CSA, RBRV, and their interaction with baseline eGFR, significantly outperformed traditional nephrometry in discrimination (apparent AUC: 0.752, optimism-corrected AUC: 0.729 vs. 0.697; DeLong test, P = 0.004) and clinical net benefit. Quadrant-based analysis revealed a compensatory \"Resilience\" phenotype, suggesting that preserving substantial RBRV may effectively buffer the detrimental impact of high surgical complexity. Serial mediation analysis revealed a pattern consistent with statistical sequential mediation: the negative association between anatomical complexity (CSA) and pentafecta achievement was not direct (OR = 0.990, P = 0.683), but rather mediated through a potential sequential pathway involving prolonged warm ischemia time and subsequent postoperative day 1 acute kidney injury (AKI) (indirect effect, P = 0.033).</p><p><strong>Conclusion: </strong>The 3D quantitative framework demonstrates superior predictive performance compared to traditional nephrometry in predicting pentafecta. Maximizing functional volume retention and preemptively mitigating the risk of ischemia-associated AKI appear paramount for individualized surgical planning and optimal long-term recovery.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Largest pediatric scrotal lipoma with perineal extension: a rare case expanding the anatomic spectrum and diagnostic pitfalls.","authors":"Ahmed Abdelmohsen","doi":"10.1186/s12894-026-02240-z","DOIUrl":"10.1186/s12894-026-02240-z","url":null,"abstract":"<p><strong>Background: </strong>Scrotal lipomas are exceptionally rare in children, with only a few cases reported worldwide and most measuring less than 7 cm. Giant pediatric scrotal lipomas with multi-compartmental perineal extension have not been previously described. This case presents the largest documented pediatric scrotal lipoma, with an analytic framework for understanding diagnostic pitfalls and rare visual documentation of surgical anatomy.</p><p><strong>Case presentation: </strong>A 5-year-old boy presented with six months of progressive left scrotal swelling clinically consistent with a large hydrocele. Ultrasound suggested heterogeneous fatty tissue, while MRI performed elsewhere was interpreted as omental herniation. Standard inguinal exploration for presumed hydrocele revealed a normal testis without a hernia or fluid collection, prompting intraoperative diagnostic reassessment. Subsequent scrotal exploration identified a well-encapsulated lipoma measuring 14 × 12 × 7 cm, located between the dartos and scrotal skin with deep extensions to the pubic arch, penile root, and pelvic floor. Complete excision was achieved while preserving all neurovascular structures. Histopathology confirmed mature lipoma. At one-year follow-up, the patient remained asymptomatic with symmetric testes and no recurrence.</p><p><strong>Conclusions: </strong>This case demonstrates how ultra-rare pediatric conditions can closely mimic common scrotal diseases, leading to diagnostic anchoring despite supportive imaging. It documents, to the best of our knowledge, the largest pediatric scrotal lipoma to date and the only case with extensive perineal extension. Intraoperative diagnostic flexibility, combined with meticulous anatomical dissection, enables safe and complete excision with excellent functional outcomes.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}