Radical prostatectomy is a common treatment option for patients with prostate cancer (PCa). In patients with a high-risk disease, the association of pelvic lymphadenectomy is recommended. This review aimed to address the main aspects of performing pelvic lymphadenectomy, including extension and anatomical aspects, number of lymph nodes (LNs) dissected, staging and presurgical planning, nomograms, benefits, and complications, in patients with high-risk PCa. We conducted a narrative review using English articles from the MEDLINE/PubMed database. The articles were selected because of their high level of evidence and importance, and we utilized the following expressions and combinations of terms: "high-risk prostate cancer", "pelvic lymph node dissection", "lymphadenectomy" and "radical prostatectomy". LN involvement in patients with PCa is an independent risk factor for poor prognosis, and this procedure increases the risk of perioperative morbidity. Extended pelvic LN dissection is indicated in high-risk patients, and nomograms are useful in determining whether LN dissection should be performed because of the risk of LN involvement. Determining whether the rate of complications increases during the procedure is important. In high-risk PCa, extended pelvic LN dissection promotes local staging better than that achieved through limited pelvic LN dissection and new imaging methods at the expense of increased risk of complications.

This study aimed to explore the effect of electroacupuncture (EA) stimulation on bladder function improvement, sleep quality and psychological state in patients with neurogenic bladder (NB) after spinal cord injury (SCI). Patients with NB after SCI treated in our hospital from January 2020 to January 2025 were retrospectively enrolled and divided into a traditional treatment group and an EA treatment group on the basis of their treatment protocols. Both groups received bladder function training, with the EA group additionally receiving EA. Bladder function was evaluated using maximum bladder capacity (MBC), intravesical pressure (IVP) and residual urine volume (RUV). Micturition frequency (MF), single voided volume (SVV) and maximum voided volume (MVV) were used to assess micturition status. The Pittsburgh Sleep Quality Index (PSQI), the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS) were used to evaluate sleep quality and psychological state. A total of 118 patients were included (56 in the EA group and 62 in the traditional group). The EA group showed significantly better improvements in bladder function and micturition indices (MBC, RUV, MF, SVV and MVV) than the traditional group (p < 0.05). The PSQI, SAS and SDS scores in the EA group were notably lower, indicating marked improvements in sleep quality and psychological state (p < 0.05). The EA group also had a lower incidence of adverse reactions (p < 0.05). EA stimulation combined with bladder function training effectively improves bladder function, micturition, sleep quality and psychological state in patients with NB after SCI.

Benign prostatic hyperplasia (BPH) is a condition prevalent in men over 50 years old and characterised by benign prostatic obstruction and lower urinary tract symptoms. The RezumTM system, a minimally invasive technique based on thermal ablation using water vapor, aims to provide an effective treatment with reduced surgical effect and preserved quality of life. A bibliographic review was conducted on publications indexed in PUBMED and SCOPUS from 2015 to 2023. Sixteen studies, including clinical trials and multicentre experiences, on the adverse effects (AEs) and tolerance to RezumTM treatment were selected. Data were organised in accordance with Clavien-Dindo criteria and compared with bipolar transurethral resection of the prostate (TURP). The main AEs associated with RezumTM include haematuria (1.7%-71.7%), dysuria (1.79%-64.5%), frequency/urgency (3.2%-50%), acute urinary retention (4.4%-33.8%) and urinary tract infection (2%-20%). These events are generally mild to moderate (Clavien-Dindo I-II) and tend to resolve spontaneously or with symptomatic treatment. Erectile dysfunction was reported in less than 5.56% of all reviewed studies, highlighting its limited impact on sexual function. Re-treatment rates were within the range of 4.4%-8.33%, associated with the conservative therapeutic strategy. The RezumTM system demonstrates a favourable safety profile with mild/moderate and manageable AEs and high tolerability (100% across reviewed studies). It is an effective and minimally invasive alternative for managing BPH, particularly for patients seeking to minimise surgical risk and preserve sexual function.

In primary hyperoxaluria (PH), clinical manifestations can initiate during early childhood. Given the high prevalence of urinary lithiasis and chronic kidney disease (CKD) among adult population, in which clinical manifestations of PH after childhood, diagnosis becomes more difficult. This guide was developed to improve the diagnostic and therapeutic fields of PH in adult patients for clinicians. PH can cause (i) kidney stones and (ii) calcium oxalate crystal deposition within the kidney tissue (oxalate nephropathy). Clinical criteria for suspected PH in adults include the following: (i) Recurrent stone disease (in children, however, it should be suspected in the first episode); (ii) Nephrocalcinosis that is particularly associated with decreased glomerular filtration rate (GFR); (iii) Presence of oxalate crystals (calcium oxalate monohydrate and whewellite) in any biological fluid or tissue. To the above, the following can be added: (iv) Hyperoxaluria without clear cause of secondary hyperoxaluria; (v) Oxalate urinary excretion >1.0 mmol/1.73 m2 body surface area in two samples; (vi) Kidney transplant recipients with previous CKD of unknown aetiology or previous history of recurrent urolithiasis and presenting graft nephrocalcinosis and GFR drop with no other clear cause. Routine PH screening of all adult patients with hyperoxaluria is costly strategy and therefore not recommended. Suspected PH in adults should be guided in accordance with clinical criteria. In patients with a confirmed PH diagnosis, all efforts should be directed towards adequate genetic and biochemical characterisation given that each patient can benefit from various therapeutic strategies.

The study aimed to analyse the comparative effect of low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet-rich plasma (PRP), and their combination for treating arteriogenic erectile dysfunction (ED). This prospective observational study involved men diagnosed with arteriogenic ED over six months. Four hundred men aged 35-65 with ED, diagnosed using the International Index of Erectile Function (IIEF-5) and penile colour Doppler ultrasonography (USG), joined the research. The participants were divided into four groups: Li-ESWT, PRP, Li-ESWT + PRP, and Control. Outcomes were assessed at baseline and at one, three and six months post-treatment, focusing on changes in IIEF-5 scores and penile haemodynamics, including peak systolic velocity (PSV) and end-diastolic velocity (EDV). Li-ESWT significantly improved IIEF-5 scores from baseline to three months (p = 0.001), with sustained but reduced effects at six months (p = 0.001). PRP alone showed mild improvement at one month (p = 0.028), with no significant effect persisting at six months (p = 0.119). Combination therapy demonstrated the most pronounced and sustained improvement in IIEF-5 scores, particularly at three and six months (p = 0.001). Haemodynamic analysis revealed a significant increase in PSV at three months in the Li-ESWT and combination groups (p = 0.001) with mild regression at six months (p = 0.003). EDV changes were negligible across all groups and time points (p > 0.05). Combining Li-ESWT and PRP provided the most substantial and sustained improvement in erectile function and arterial haemodynamics. While Li-ESWT demonstrated notable efficacy, PRP alone showed limited and transient benefits.

While enzalutamide has demonstrated reliable therapeutic efficacy in the management of prostate cancer (PC), a substantial proportion of patients eventually develop resistance to this medication after prolonged therapy. Despite this, the identification of biomarkers to effectively predict clinical outcomes in PC patients who exhibit resistance to enzalutamide remains uncertain. The aim of this study was to identify a specific gene associated with acquired resistance to enzalutamide in PC and to investigate the potential prognostic value of this gene. The GSE183100, GSE147541, and GSE16560 datasets were obtained from the Gene Expression Omnibus database. Differential gene expression analysis was conducted using the DESeq2 R package and Wilcoxon's rank-sum test. Subsequently, biological process enrichment analysis and gene set variation analysis were performed to identify a promising candidate gene. Additionally, the correlation between the proportions of immune cell infiltration and the expression of candidate genes was evaluated. Finally, the potential implications of these candidate genes on survival outcomes were investigated. A comprehensive analysis identified a total of 975 differentially expressed genes, predominantly involved in biological processes related to angiogenesis, inflammatory response, positive regulation of cell division, and membrane potential. Notably, secreted frizzled-related protein 1 (SFRP1) expression demonstrated strong, favorable correlations with both angiogenesis and the infiltration of Regulatory T cells. Moreover, the overexpression of SFRP1 was found to be closely associated with improved prognosis in patients with PC. In conclusion, the downregulation of SFRP1 in enzalutamide-resistance PC is associated with angiogenesis and cellular infiltration. This study identified SFRP1 as a diagnostic biomarker for patients with PC who have developed acquired enzalutamide resistance. These findings provide an important theoretical foundation for the development of novel and complementary therapeutic approaches for PC management.

Ureteroscopic lithotripsy for renal or ureteral stones is a standard technique performed by every urologist. Double J (DJ) stents are a part of this surgery. This study investigated how patients' compliance affects the time of DJ stent removal. The cases of patients aged 20-80 years old who underwent transurethral ureteroscopic lithotripsy were reviewed. The duration of postoperative DJ stent retention was set as 21-28 days in all cases, and a duration of 14-35 days indicated compliance. Short durations signified intolerance, and long durations were considered negligence. The age, gender, stone side, level and size, and educational level and behaviours regarding stent removal of the patients were compared. A total of 146 patients were included. The duration of DJ stent retention ranged from two days to 152 days (mean 36.6 days). Amongst the patients, 66 were compliant with the recommended removal time of 28 ± 7 days, whereas 80 were noncompliant. The mean age of the group unable to tolerate stents was significantly lower (p = 0.032) that those of other groups. When the patients were divided into two groups on the basis of educational level (low and high), a significant relationship was observed between compliance with stent removal timing and educational level (p = 0.036). Postoperative planning is critical for young patients. This study demonstrated that a significant number of patients are unaware of the timing for DJ stent removal. Educational status, in particular, should be taken into consideration. Various measures, such as mobile phone applications, reminder short message service (SMS) messages and record-keeping systems, can help prevent complications caused by forgotten stents.

Pulmonary embolism (PE) secondary to lymphocyst formation after robotic-assisted laparoscopic radical prostatectomy (RALRP) is a rare but serious complication. Although most patients with pelvic lymphocysts receive effective conservative treatment, there is no consensus on treatment strategies for patients who do not respond to conservative treatment. This case report highlights the clinical features, diagnostic challenges, and treatment approaches for managing this condition. A 61-year-old male with prostate cancer (pT3N0M0) underwent RALRP. One week after discharge, he developed swelling and pain in his right lower limb, with localised warmth and worsening symptoms upon activity. A pelvic lymphocyst was suspected and the patient was initially managed symptomatically prior to discharge. However, three weeks later, he returned with persistent right lower limb edema and new-onset dyspnea. Further evaluation confirmed a secondary PE due to the lymphocyst. The patient showed significant improvement after a comprehensive treatment strategy, including anticoagulation, thrombolysis, and inferior vena cava filter placement. Concurrently, the lymphocyst was successfully managed with computed tomography (CT)-guided percutaneous drainage and sclerotherapy, leading to complete resolution. The patient was discharged without complications, and follow-up showed no recurrence. PE secondary to lymphocyst formation is an uncommon but serious complication after radical prostatectomy. Early detection and intervention in high-risk patients are essential to improve patient outcomes.

This study aims to investigate the potential use of qualitative interferon-γ release assay, specifically T-spot testing focusing on culture filtrate protein 10 (CFP-10) positivity, in predicting the response of patients with high-risk non-muscle invasive bladder cancer (NMIBC) to intracavitary Bacillus Calmette-Guerin (BCG) vaccine instillation. Patients diagnosed with high-risk NMIBC were retrospectively identified from an institutional database and subsequently underwent prospective T-spot testing. Following the completion of an adequate course of BCG instillation, patients who were unresponsive to BCG were assigned to the study group. By contrast, those who remained recurrence free for at least one year post-treatment were assigned to the control group. In this cohort of 42 patients with high-risk NMIBC, the median age was 67, and 40.0% were unresponsive to BCG. The distribution comprised 50.0% pTa and 81% high-grade cases. Over a median follow-up of 18 months, the positive BCG response varied between pTa (81%) and pT1 (38%; p = 0.005), and T-spot testing revealed positivity in 75.0% of the control group and 92% in BCG-unresponsive patients (p = 0.235). Notably, CFP-10 positivity was significantly more prevalent in the BCG-unresponsive group, observed in 91.7% of the patients, in contrast to 35.7% in the control group (p = 0.004). T-spot test or more specifically CFP-10 positivity is a potential marker for predicting response to BCG instillation in patients with NMIBC.

This study aimed to evaluate perioperative outcomes and postoperative complications following minimally invasive radical cystectomy with ileal conduit (RCIC) performed under an enhanced recovery after surgery (ERAS) protocol, using the Clavien-Dindo classification (CDC) and the comprehensive complication index (CCI). An ambispective study (2018-2022) was conducted, collecting demographic, perioperative and postoperative data, with a focus on complications among patients treated during and outside the COVID-19 period. Results were compared between surgeries conducted during the COVID-19 pandemic, including the first wave, and those performed in a non-COVID period. Among these 90 patients, 49 underwent surgery during the complete COVID-19 period, compared with 41 patients in the pre- and post-pandemic control period. Additionally, 15 of the cases occurred during the first wave of the pandemic. The COVID-19 group showed a higher rate of pN0 staging (87.8% vs 67.5%, p = 0.021) and fewer pN1 cases (2% vs 20%, p = 0.005) than the control group. The most common complications were genitourinary (71, 78.9%), infectious (59, 65.6%) and gastrointestinal (54, 60%). Median CCI increased significantly with each ascending CDC (r = 0.934, p < 0.001). Notably, 20.3% of patients in CDC ≤3a were reclassified to severe morbidity (CCI ≥33.7), with elevated rates during COVID-19 periods (46.7% and 42.9% vs 34.1%). CCI showed a more consistent correlation with length of stay than CDC (r = 0.551, p < 0.001 vs r = 0.460, p < 0.001). Minimally invasive RCIC during the COVID-19 pandemic was associated with increased postoperative morbidity. Compared with RCIC, the CCI provides a more accurate estimation of morbidity burden and should be incorporated into standard surgical outcome reporting.