Background: Lower urinary tract symptoms (LUTS) and pain are clinically relevant problems after transurethral resection (TURBT) of nonmuscle-invasive bladder cancer. Although intravesical instillation of hyaluronic acid has already been proven to be a valid treatment for storage LUTS and pain in patients with inflammatory bladder syndrome, its efficacy in patients who undergo TURBT is unknown. This study aimed to present the results of a prospective, randomized, controlled, clinical pilot study on the safety and clinical performance of HydealCyst (Fidia Farmaceutici S.p.A., Italy), a device formulated to provide progressive, long-lasting intravesical release of hyaluronic acid. Materials and methods: Adults diagnosed with nonmuscle-invasive bladder cancer and scheduled for TURBT were included and underwent 4 visits up to 25 days after TURBT. Of the 47 patients who completed the investigation, 25 participants received 2 postoperative intravesical instillations with HydealCyst. The efficacy of HydealCyst on storage LUTS, pain, urinary symptoms, and patients’ quality of life was evaluated using validated questionnaires. Results: Although the overall LUTS were similar in the 2 experimental groups, lower micturition frequency and fewer daytime micturitions were observed in patients treated with HydealCyst. These patients also showed a significant reduction in pain ( p = 0.03) 3 days after catheter removal and better quality of life at the end of the study. The device was well tolerated, with no treatment-emergent adverse events of severe intensity. Conclusion: The results from this pilot study indicate a clinically meaningful improvement of symptoms after 2 instillations of HydealCyst, supporting this intervention as a potentially effective treatment for LUTS and pain after TURBT.

Background: This study aimed to explore the functions and potential mechanisms of PIWI-interacting RNA–related genes (piRPGs) in bladder cancer (BC) development and to identify potential prognostic genes. Methods: This study used differential analysis and machine learning techniques to identify the differentially expressed piRPGs in BC. Consensus clustering was performed on The Cancer Genome Atlas–Urothelial Bladder Carcinoma dataset, and univariate and multivariate analyses were conducted to construct a BC prognostic model consisting of 3 piRPGs. Kaplan-Meier survival curves were used for survival analysis. Quantitative polymerase chain reaction was performed to validate the expression levels of piRPGs in BC cells and tissues. The functional roles and potential mechanisms of piRPGs in BC were investigated via single-cell sequencing and differentially methylated position sequencing. The DSigDB and CellMiner databases were used to screen for small-molecule drugs associated with piRPGs. Results: This study identified 6 piRPGs that were significantly associated with BC: MAPK13, INHBA, LAMB2, DDX3X, TARBP2, and CDK2. A prognostic model comprising MAPK13, INHBA, and LAMB2 was constructed using consensus clustering technology. Kaplan-Meier curves demonstrated significantly prolonged survival in cluster 2 compared with cluster 1 ( p < 0.01), validating the effectiveness of the prognostic model. Single-cell sequencing confirmed that MAPK13 expression was significantly upregulated in bladder tissues ( p < 0.001). Methylation site sequencing and methylation-specific polymerase chain reaction revealed significantly decreased methylation levels of INHBA and MAPK13 in BC tissues, which were inversely correlated with their expression levels. Conclusions: This study effectively developed a 3-gene prognostic signature comprising MAPK13, INHBA, and LAMB2 using consensus clustering and multifactorial logistic regression. In addition, the functional roles and intrinsic mechanisms of piRPGs in bladder carcinogenesis were comprehensively explored using single-cell sequencing, methylation sequencing, and functional enrichment analysis.

Background: Male stress urinary incontinence (MSUI) is a distressing condition that often results from radical prostatectomy, transurethral resection of the prostate, or other pelvic procedures. Despite the limitations of artificial urinary sphincters (AUS), they have historically been considered the gold standard. Emerging treatments offer varying efficacies and safety levels. This study aimed to evaluate and compare the efficacy, safety, and clinical outcomes of current MSUI treatment modalities, including AUS, adjustable transobturator male system (ATOMS), Pro Adjustable Continence Therapy, AdVance Non-adjustable Male Sling System, and duloxetine. Methods: PubMed, covering prospective and retrospective analyses of MSUI treatments in postprostatectomy patients, was searched for relevant studies published between 2006 and 2024. Data on treatment efficacy (dry matter rate, improvement rate, and reduction in incontinence severity) and safety outcomes (complication and explanation rates) were extracted. Results: A total of 46 studies comprising 7841 patients were analyzed. Artificial urinary sphincters demonstrated the highest dryness rate (72.03%), whereas ATOMS had the highest improvement rate (85.56%) and the lowest surgical explantation risk (9.45%). Pro Adjustable Continence Therapy and AdVance yielded moderate efficacy, whereas duloxetine had the lowest complication rate (18.79%). Conclusions: Artificial urinary sphincters may be the most effective treatment for dryness, whereas ATOMS could offer high improvement rates with a lower risk of explantation and complications. Duloxetine demonstrated a strong safety profile as a pharmacological option, although the evidence remains limited. Given the heterogeneity of the existing studies, future prospective randomized trials are needed to refine treatment selection and optimize MSUI management.

Background: ChatGPT is not yet sufficiently reliable for answering clinical questions relevant to direct patient care. We hypothesized that a GPT model trained exclusively on expert guidelines would provide more accurate, guideline-concordant responses. Materials and methods: With permission from the European Association of Urology, we developed UroGPT, a custom GPT model trained solely on the European Association of Urology guidelines. We posed 25 clinical questions derived from the Male Infertility Guidelines and expert opinions to both the standard ChatGPT (GPT-4o) and UroGPT. Responses were anonymized and graded by 2 blinded reviewers as “complete and accurate,” “incomplete but accurate,” and “incorrect or misleading.” Guideline concordance was compared using the chi-square test. Results: UroGPT demonstrated significantly greater concordance with guideline-based responses than ChatGPT ( p < 0.001). UroGPT provided 94% (47/50) complete and accurate responses, whereas ChatGPT provided only 38% (19/50). ChatGPT also produced a significantly higher rate of incorrect or misleading responses (52% vs. 4%). Inter-reviewer agreement was higher for UroGPT (88% vs. 48%), suggesting that its answers were clearer and more consistent with the guidelines. ChatGPT frequently overgeneralized, recommended unsupported interventions, or offered non-guideline-based lifestyle advice. However, both models failed to answer correctly 2 high-stakes questions regarding orchiectomy in patients with undescended testes. Conclusions: UroGPT markedly outperformed ChatGPT in guideline concordance. Training artificial intelligence models on expert-authored content represents a meaningful step toward developing clinically useful large language models. However, UroGPT is not yet appropriate for direct patient care and should currently be used only for research and academic purposes.

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for 25% urology clinic visits. Due to significant overlap with other conditions, CP/CPPS is frequently misdiagnosed and inadequately managed. Therefore, we provided a simplified diagnostic and treatment approach to CP/CPPS by subdividing it into distinct subcategories. Materials and methods: We systematically reviewed the published literature about CP/CPPS and its “associated entities”, including interstitial cystitis/bladder pain syndrome, chronic bacterial vesiculitis, symptomatic prostate calcification, pudendal neuropathy, male accessory gland Inflammation, and Chlamydia trachomatis infection. We applied the UPOINTS system to differentiate CP/CPPS phenotypes, using male accessory gland inflammation solely to flag potential inflammatory–pelvic pain overlap. Results: The review yielded an evidence base of 140 articles pertaining to CP/CPPS treatment antibiotics, α-blockers, anti-inflammatory drugs, phytotherapeutics, neuromodulators, physical therapy, local blocks, injections, and minimal invasive treatments. CP/CPPS, interstitial cystitis/bladder pain syndrome, chronic bacterial vesiculitis, symptomatic prostate calcification, pudendal neuropathy, and C trachomatis infection, and developed type-specific, step-by-step diagnostic and therapeutic algorithms. The proposed treatment model includes physiotherapy, minimally invasive options, and innovative interventions. Conclusions: Dividing CP/CPPS into 6 distinct subtypes offers clinicians more targeted guidance when selecting appropriate diagnostic tools and therapeutic interventions. Sperm analysis is recommended for patients with a history of infertility, painful ejaculation, or hematospermia, whereas pyospermia warrants investigation using semen cultures, polymerase chain reaction testing, and transrectal ultrasound. Ct-infection should be ruled out in young patients with prostatitis-like symptoms, burning micturition, “penile tip irritation,” and a thick urethral discharge. Patients over 50 years of age who have failed conventional therapy may require cystoscopy. Transrectal ultrasound can help rule out clustered prostatic calcifications, especially in older, overweight patients with a persistently elevated International Prostate Symptom Score and an increased white blood cell count in postprostatic massage urine. This approach is recommended for guiding CP/CPPS treatment.

Abstract Robot-assisted kidney transplantation (RAKT) is a new, minimally invasive option for kidney transplantation with great application prospects. This narrative review aimed to outline the developmental history of RAKT, existing technology, and its application in different types of kidney transplant surgery. The challenges with RAKT and the solutions to those challenges in practical operation are analyzed as well, to provide reference for the application of robots in kidney transplantation.