Complete urinary tract exenteration (CUTE) is an extremely radical procedure for multifocal urothelial carcinoma (UC) involving the bilateral upper urinary tract and the bladder, inevitably requiring postoperative hemodialysis. However, reports on robot-assisted CUTE are limited, and its perioperative safety has not been sufficiently established. The role of perioperative management in this highly invasive procedure remains unclear. This study aimed to report two patients with multifocal UC who underwent robot-assisted CUTE without preexisting dialysis, with perioperative management including hemodialysis initiation. Two non-dialysis patients with multifocal UC underwent robot-assisted CUTE following neoadjuvant chemotherapy, as postoperative renal failure was inevitable. Patient 1 received gemcitabine plus cisplatin, whereas Patient 2 initially received gemcitabine plus cisplatin, but was subsequently switched to gemcitabine plus carboplatin due to renal dysfunction developing. Both patients achieved a partial response. Given concerns regarding perioperative hemodynamic instability associated with this highly invasive procedure, an arteriovenous shunt was not created preoperatively; instead, jugular catheter-based dialysis access was used, with a planned arteriovenous shunt to be created at a later stage. Surgery was performed using the da Vinci Xi system with two re-docking procedures. The operative times were 461 and 456 min, and estimated blood losses were 90 and 22 ml. Both patients required postoperative blood transfusion. Hemodialysis was initiated on postoperative day 1. No major perioperative complications occurred, and the patients were discharged on postoperative days 21 and 18. Robot-assisted CUTE may be a feasible surgical option for selected non-dialysis patients with multifocal UC. This approach may enable a safe transition to postoperative dialysis and favorable recovery, while allowing for complete surgical resection with acceptable perioperative outcomes. Further studies are necessary to define its clinical role.

The purpose of this study is to investigate the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on lower urinary tract symptoms (LUTS) in individuals with type 2 diabetes mellitus (T2DM). While SGLT2i are effective antidiabetic agents with cardiovascular and renal benefits, concerns remain about their impact on LUTS. This prospective observational study included 47 patients with T2DM without organic urinary tract disease or autonomic neuropathy. The Overactive Bladder (OAB)-Validated 8-question (OAB-V8) questionnaire was administered at baseline and reassessed at months 1 and 3 of SGLT2i treatment. The associations of alterations in symptom scores with metabolic parameters were assessed using Spearman's rank correlation. The mean overall OAB-V8 score decreased from 10.1 ± 5.0 to 8.8 ± 6.5 at month 1 (p = 0.01), with no significant difference at month 3 (p = 1.00). Subgroup analyses suggested transient improvement in patients with OAB (n = 17), with scores decreasing from 15.4 ± 4.0 to 12.4 ± 5.7 at month 1 (p = 0.04), followed by a return to baseline at month 3 (16.0 ± 9.0; p = 0.69). Patients without OAB (n = 30) showed stable scores at month 1 (7.1 ± 2.3 to 6.9 ± 6.1; p = 0.24) and dropped significantly by month 3 (6.6 ± 5.4; p = 0.03). Changes in overall scores were independent of body mass index or glycated hemoglobin levels, both in patients with and without OAB. Short-term SGLT2i therapy did not appear to worsen OAB symptoms in patients with T2DM. The results of the subgroup analyses should be viewed cautiously and validated in studies with larger populations. These results provide preliminary reassurance but highlight the need for larger, controlled studies with longer follow-up. The online version contains supplementary material available at 10.1007/s13340-026-00902-9.

Urothelial carcinomas are malignancies arising from the lining epithelium of the urinary tract. It can develop anywhere starting from the renal pelvis to the urethra, involving the bladder and ureter in between. Multifocal occurrences as well as metachronous or synchronous recurrences have been reported in urothelial carcinoma, particularly in cases of upper tract urothelial carcinomas. Seeding of cancer cells and field cancerisation are two well explored hypotheses explaining the possible cause for such unique tumour characteristic. Here, we report a case of multifocal urothelial carcinoma in a 68-year-old female, presenting with carcinoma involving the renal pelvis, extending along the entire length of the ureter to finally infiltrate the bladder wall. Neo-adjuvant chemotherapy could not be administered due to poor renal function owing to hydronephrosis. Patient was surgically managed by radical nephrectoureterectomy and radical cystectomy. Postsurgery, resection margin of the specimen revealed microscopic evidence of residual neoplastic lesion of low malignant potential, necessitating the need for active long-term surveillance for possible recurrence. However, patient unfortunately succumbed to possible disease related health complications closely after surgery, preventing follow-up and further evaluation of the disease course. Synchronous bladder carcinoma with upper tract urothelial carcinoma is novel owing to its multifocality and an aggressive clinical course. Such a presentation of upper tract urothelial carcinoma indicates a simultaneous affliction of the entire urinary tract increasing the risk of residual disease and recurrence even with extensive radical surgery. Long-term aggressive follow-up is usually warranted in these cases to improve overall survival and cancer-specific survival.

Patients receiving dialysis who have diabetes have a high burden of dysglycemia. Whereas traditional glycemic markers have limited accuracy and convenience in dialysis, continuous glucose monitoring (CGM) provides automated, less invasive, and more comprehensive glycemic data than do conventional measures. However, it remains unclear whether CGM is associated with improved clinical outcomes in patients undergoing dialysis. We examined the association between CGM use versus non-CGM use and survival among U.S. veterans receiving dialysis who also have diabetes, using linked national Veterans Affairs, U.S. Renal Data System, and Medicare data. We examined data from veterans undergoing dialysis and with diabetes with incident CGM use (newly prescribed CGM) versus non-CGM use over the period January 2012 to December 2023 matched by propensity score (PS) to address confounding by indication and who were followed for all-cause mortality events through February 2025. Associations of CGM use versus non-CGM use with death were evaluated using complete case analysis and multiple imputation. Among 2,008 patients in the complete case analysis cohort, CGM use was associated with a lower mortality risk in PS-matched unadjusted and doubly adjusted Cox models (reference: non-CGM use; hazard ratio [HR] 0.86 [95% CI 0.76, 0.98]; and 0.83 [95% CI 0.75, 0.92], respectively). Among 3,088 patients in the multiple imputation cohort, CGM use was also associated with greater survival in PS-matched unadjusted and doubly adjusted Cox models (HR 0.88 [95% CI 0.77, 0.99]; and 0.84 [95% CI 0.73, 0.96], respectively). In veterans receiving dialysis who also had diabetes, incident CGM use was associated with better survival versus non-CGM use. Further studies are needed to determine underlying mechanisms and the impact of CGM on other dialysis outcomes.

Peritoneal dialysis use in 2009-2010 was concentrated in a few high use communities with a similar demographic profile. From 2011 to 2020, peritoneal dialysis use expanded most in communities where it had previously been less common. This suggests that the gain in peritoneal dialysis use was broad and not just the result of further increases in high use areas. Peritoneal dialysis (PD) use in the United States has historically varied significantly from region to region and community to community. Studies have reported greater PD use in higher income, Western communities compared with lower income, Northeastern communities. We sought to examine the extent to which recent increases in PD use truly resulted in expanded access at the community level (versus increasing in areas that already had high PD use). We used the United States Renal Data System to examine PD initiation patterns across health service areas (HSAs) based on pre-expansion PD use. We categorized PD use in each HSA in 2009-2010 as high (≥11% of patients on dialysis using PD), medium (5.5% to <11%), or low (<5.5%). We then identified incident dialysis patients from 2011 to 2020 and used logistic regression to evaluate how the odds of PD initiation among new dialysis patients changed over this period by baseline HSA PD use category. We then recategorized HSAs using 2020 data to determine the number that changed PD use categories over the study period. We included 755 HSAs in the analysis and subsequently examined 1,195,477 patients from those HSAs who initiated dialysis from 2011 to 2020. The odds of a patient initiating PD as their incident dialysis modality increased most in low PD HSAs (adjusted odds ratio [OR], 1.49 per 5 years; 95% confidence interval [CI], 1.45 to 1.52), followed by medium (adjusted OR, 1.37; 95% CI, 1.35 to 1.39) and high PD HSAs (adjusted OR, 1.17; 95% CI, 1.14 to 1.20). More than half (51%) of HSAs previously categorized as low PD had become medium or high PD HSAs in 2020. Use of PD as the incident dialysis modality increased most in HSAs where it had previously been less common, suggesting that the gain in PD use was broad and not merely the result of further increases in already high use areas.

To evaluate the safety and efficacy of flexible ureteroscopy (f-URS) with a flexible and navigable suction ureteral access sheath (FANS) compared with mini-percutaneous nephrolithotomy (mPCNL) in the treatment of 2-3 cm upper urinary tract stones (UUTS), with a prespecified subgroup analysis for stones ≥2 to <2.5 cm. This randomized controlled trial enrolled 326 patients with 2-3 cm UUTS between June 2023 and December 2025. Patients were randomly assigned in a 1:1 ratio to undergo either f-URS with FANS or mPCNL. A prespecified subgroup analysis was conducted for stones measuring ≥2 to <2.5 cm. The primary outcomes were the immediate and 1-month stone-free rate (SFR). Secondary outcomes included the operative duration, decrease in haemoglobin, hospital stay, and complication rate. The baseline characteristics were comparable between the two groups. In the overall 2-3 cm cohort, the FANS group achieved immediate and 1-month SFRs comparable to those of the mPCNL group. Although the operative time was longer in the FANS group, it was associated with significantly less haemoglobin loss and a shorter hospital stay, with no significant difference in infection-related complications. Notably, in the subgroup of stones ≥2 to <2.5 cm, the FANS group demonstrated a non-inferior SFR at both time points, and the operative time was not significantly longer than that of the mPCNL group. For 2-3 cm UUTS, f-URS with FANS offers a SFR comparable to that of mPCNL, along with the advantages of reduced blood loss and shorter hospitalization. In the ≥2 to <2.5 cm subgroup, FANS shows comprehensive benefits over mPCNL. These findings support FANS as an effective alternative to mPCNL for 2-3 cm stones and a potentially preferred option for stones measuring 2-2.5 cm.

A gated pathway for suspected urinary tract infection in dementia.

Utility of FRET substrates in bladder cancer diagnosis.

To systematically map existing literature on antimicrobial stewardship (AMS) practices and identify critical gaps in the management of suspected urinary tract infections (UTIs) in long-term care facilities (LTCFs) worldwide. A scoping review of studies published between 2014 and 2024 was conducted using EBSCOhost Advance (Ageline, MEDLINE Ultimate, and CINAHL Ultimate), PubMed, Scopus, Google Scholar, and TRIP databases. The review followed the Joanna Briggs Institute (JBI) methodology and was reported in accordance with the PRISMA-ScR checklist. Of 4327 records screened, 74 studies (including 2 identified through hand searching) met inclusion criteria. Data were synthesised deductively into four overarching themes: (1) prevalence of UTIs in LTCFs over the past decade; (2) AMS practices and existing gaps; (3) underlying concepts and contextual factors shaping AMS implementation; and (4) risks associated with deviations from evidence-based practice. Theme 2 was further inductively analysed, revealing five subthemes: (i) suboptimal prescribing practices; (ii) diagnostic inaccuracies and misdiagnoses; (iii) limitations in documentation and review processes; (iv) deficits in knowledge, training, and guideline adherence; and (v) contextual and system-level influences. This review presents a global synthesis of evidence on the high prevalence of UTIs and persistent critical gaps in antimicrobial stewardship practices in LTCFs. We found there is widespread overdiagnosis of asymptomatic bacteriuria, driven by unreliable diagnostic practices, resulting in excessive exposure to antimicrobials and increased risk of antibiotic resistance and other adverse outcomes. The review also highlights the central role of frontline workers in UTI diagnosis and antimicrobial decisions. Furthermore, it advocates for a targeted, behaviourally informed AMS initiative that emphasises diagnostic clarity and implementation of evidence-based practices in LTCFs.

Societal guidelines for the management of extraperitoneal bladder injuries (EBIs) are based on limited evidence. Current recommendations support nonoperative management of simple EBIs despite a high persistent urinary leak rate. Conversely, operative management is often associated with a lower leak rate. This study evaluated clinical outcomes associated with operative versus nonoperative management of EBIs. We hypothesized that cystorrhaphy would be associated with fewer persistent urinary leaks, reduced catheter duration, fewer infectious complications, and decreased interval imaging use and timing. An 8-year retrospective review (2017-2024) of EBIs was conducted within a university-based Level I/II trauma system. Those who died during hospitalization, underwent suprapubic catheterization, or sustained ureteral, urethral, or intraperitoneal bladder injuries were excluded. Demographic, injury, and management variables were abstracted. Patients were stratified by initial management strategy (operative vs. nonoperative). Outcomes included persistent urinary leak, catheter duration, infectious complications, and interval imaging use and timing. Seventy patients met the inclusion criteria, of whom 39 (55.7%) underwent operative repair. Demographics and injury characteristics were similar across cohorts, although operative patients had larger (2.3 vs. 1.3cm, p <0.01) and higher-grade injuries (American Association for the Surgery of Trauma grade ≥3: 71.8% vs. 25.8%, p <0.01). Operative repair was associated with fewer urinary leaks on interval imaging (2.6% vs. 25.8%, p =0.01) and shorter urinary catheter duration (17.6 ± 13.2 vs. 31.1 ± 24.9d, p =0.01). No significant differences were observed between cohorts with respect to catheter-associated urinary tract infections (38.5% vs. 45.2%, p =0.57), pelvic hardware infections (15.4% vs. 12.9%, p =0.73), frequency (84.6% vs. 96.8%, p =0.12) or timing (15.9 vs. 19.7d, p =0.39) of interval imaging. Operative repair of EBIs is associated with reduced urinary leak rates and catheter duration despite greater bladder injury severity. Other outcomes were similar between strategies. Concomitant cystorrhaphy during non-urologic abdominal or pelvic operations may expedite recovery in selected patients. ( J Trauma Acute Care Surg . 2026;101: 65-70. Copyright © 2026 The Author(s). Published byWolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.). Therapeutic/Care Management; Level III.

Leiomyomas (LMs) represent the most frequent mesenchymal tumors of the urinary bladder. Despite their relative frequency, large clinicopathological studies are scarce, and their pathogenesis remains poorly understood. In this study, we performed a clinicopathological analysis of 35 bladder LMs and explored whether they share pathogenic mechanisms previously documented in uterine LMs. The tumors occurred in 18 women and 17 men, with a median age of 55 years (range: 20 to 78y). Clinical data were available for 30 cases (85%). Most tumors were incidentally discovered (16/30, 53%), while the remaining patients presented predominantly with lower urinary tract symptoms. Ten patients had a prior history of cancer, and 3 women had a history of uterine LM. Tumor size, available in 12 cases, ranged from 6 to 66mm (mean, 31mm). Histologically, most tumors showed a uniform morphology, consisting of well-circumscribed nodules composed of bland smooth muscle cells without mitotic activity. Rare findings included extensive necrosis (3/35, 8%) and a pseudohyperplastic appearance (1/20, 5%). On immunohistochemistry, a subset of tumors, predominantly in females, expressed estrogen receptors (7/28, 25%), progesterone receptors (5/24, 21%), and androgen receptors (10/23, 43%). HMGA2 expression was observed in one case (1/27, 4%). Fumarate hydratase (FH) expression was retained in all tested tumors (n=31); 2SC expression was detected in 4 tumors (4/32; 12%), all with preserved FH and lacking distinctive histomorphological features of FH-deficient LMs. DNA sequencing of 2SC-positive tumors identified a pathogenic FH variant in one of the 4 analyzed cases at a low variant allele frequency. No other known pathogenic variants, including MED12 commonly seen in uterine LMs, were detected. Altogether, this study characterizes the clinicopathological features of large cohort of bladder LMs, highlighting unrecognized morphologic features, including cases with massive necrosis. Our findings suggest that bladder LMs differ pathogenetically from their uterine counterparts, with a more limited role for hormone receptor signaling and distinct genetic alterations.

SLC20A1 encodes the ubiquitously expressed phosphate transporter PiT1, a protein with roles extending beyond phosphate homeostasis to include regulation of proliferation, differentiation, apoptosis, and embryonic development. While heterozygous SLC20A1 variants have been associated with urinary tract malformations, the impact of biallelic loss-of-function was unknown. We report the first human case of a biallelic homozygous predicted loss of function variant in SLC20A1 (c.674_675delAA; p.K225TfsX34) in a child with multiple congenital anomalies including tetralogy of Fallot, unilateral renal agenesis, postaxial polydactyly, growth impairment, and developmental delay. PiT1 expression was decreased in fibroblasts of the proband. Transcriptome analysis of patient-derived fibroblasts suggests significant dysregulation of pathways critical for organogenesis, including PI3K-Akt, Wnt, MAPK, and BMP signaling. Population screening identified a carrier frequency of 1:432 among Ashkenazi Jewish individuals. Our findings expand the phenotypic spectrum of SLC20A1-related disease and provide evidence that biallelic PiT1 deficiency causes a previously unrecognized multisystem developmental disorder.

To find the cause of infectious diseases such as urinary tract infections, a the diagnostic patterning test was used. In this method, the whole blood and serum samples for every person were dried on a glass substrate to create a special pattern due to formation of central and peripheral regions. This process was performed during 1h at 25°C which is much shorter than the classical and instrumental methods. The resulting patterns can be observed by an optical microscope. The study aimed to classify the UTI patients and healthy controls (N=600). In addition, the images of dried patterns were captured by a camera and the classification analysis was done by convolutional neural network algorithm, executed by graphical user interface. The result of analysis was available after a few minutes, indicating that the proposed method achieved accuracies of 90.8% (through the analysis of the dried blood spot) and 86.6% (through the evaluation of the dried serum spot) for discriminating the patients from healthy participants. This method could become popular because it has a simple design and does not require skilled personnel, toxic reagents and expensive equipment. Most importantly, it can identify the contaminated sample as well as the contaminant in a shorter time than other common methods.

Mice have been used as models of urinary tract infection (UTI) for decades and laid the basis for the fundamental understanding of UTI pathogenesis in humans. Here we report that the high urine osmolarity of mice impacts key aspects of Escherichia coli UTI pathogenesis and represents a confounder for the translation of results to humans.

Determination of urinary and serum myeloperoxidase and interleukin-6, -8 -10 in dogs with subclinical bacteriuria and urinary tract infections.

Invasive urodynamic study(UDS) remains the gold-standard test for diagnosing and characterizing the neurogenic bladder. UDS being an invasive test is difficult to implement as a screening test for children who are predisposed for neurogenic bladder. An observational study was conducted to evaluate the urodynamic features of lower urinary tract dysfunction (LUTD) in follow-up pediatric surgical (nonurological primary etiology) cases "at-risk" for neurogenic bladder and the efficacy of noninvasive uroflowmetry was assessed. A prospective study was done from November 2019 to December 2022. All the postoperative patients with a history of primary non-urological congenital anomalies, aged less than 15 years presenting with LUTD were included. Noninvasive free-flow uroflowmetry and invasive UDS were done for these patients. Abnormal UDS defined in terms of voiding pattern was compared with abnormal uroflowmetry defined as inadequate Qmax and nonbell shaped flow curve. Thirty-four children with primary diagnosis of spina-bifida (n = 12), anorectal malformation (n = 20), and sacrococcygeal teratoma (n = 2) were included, who presented with LUTD at a mean age of 4.76 ± 1.60 years. 29.4% children had acontractile bladder at presentation. Abnormal findings of uroflowmetry were comparable to abnormal findings of UDS (p > 0.05; kappa > 0.7). Uroflowmetry had sensitivity of 88.2% and specificity of 82.3% in diagnosing neurogenic bladder. Delayed presentation of neurogenic bladder with irreversible detrusor changes in predisposed cases highlights the need for stringent follow-up. Noninvasive uroflowmetry has high sensitivity and specificity with respect to invasive UDS in identifying neurogenic bladder in predisposed cases; it can be implemented as a routine screening test in predisposed cases to identify the at-risk cases in advance of clinical symptoms.

Healthcare associated infections (HAI): Insights into epidemiology, microbiology, and diagnostics.

Bladder outlet obstruction (BOO) is diagnosed through clinical urodynamics, an invasive method with many limitations, including side effects or surgical complications. This study introduces evaluation strategies for BOO recognition based on uroflowmetry test. In this study, a catheter-free male lower urinary tract (LUT) model was developed for hydrodynamics simulation. The pressure and velocity distributions in urethras with different obstruction degrees were analyzed under a fixed vesical pressure, and the effect of obstruction on urine flow under transient vesical pressure input was investigated. Dynamic analysis revealed that the assignments of urethral pressure and velocity were substantially influenced by the extent and location of obstruction. The global maximum pressure and velocity differences between obstructed and healthy urethra models reached 28.8 cm H2O and 2.41 m/s, respectively, at a constant bladder pressure input of 50 cm H2O. Vortices emerged at different segments along the obstruction, resulting in energy loss in the urine stream. Based on uroflowmetry data from 300 subjects, four dimensionless evaluation parameters were designed to distinguish healthy individuals from those with BOO, with p-values of < 0.001, 0.05, 0.001, and 0.02, respectively. The distributions of pressure, velocity, and vortex provide significant guidance for customized BOO surgery. In addition, the means and indicators of dimensionless evaluation have a crucial contribution to identify male BOO by uroflowmetry examination. Trial Registration: This experiment was certified by the Chinese Clinical Trial Registry (ChiCTR2200063467).

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated efficacy and safety in patients with type 2 diabetes mellitus, chronic kidney disease, and heart failure. However, their effects in heart transplant recipients, a population with high cardiovascular risk, remain poorly understood. Clinical trials and observational studies were included. A systematic search was conducted in PubMed, Scopus, EMBASE, and Web of Science. Mean differences (MD) were calculated for continuous outcomes and risk ratios (RR) for binary outcomes, both with 95% confidence intervals (CI). Analyses were performed using RevMan version 5.4.1. Five retrospective cohort studies including 1512 heart transplant recipients (312 SGLT2i users and 1200 controls) were analyzed. SGLT2i use was not associated with significant changes in renal function (MD in eGFR: 3.96 mL/min/1.73 m2; 95% CI: -2.33 to 10.26; p = 0.22) or glycemic control (MD in HbA1c: -0.20%; 95% CI: -0.73 to 0.34; p = 0.47). Mortality was comparable between groups (RR: 0.64; 95% CI: 0.29-1.40; p = 0.26), with no significant increase in urinary tract infections (RR: 1.40; 95% CI: 0.25-7.72; p = 0.70). However, SGLT2i use was associated with significant reductions in body mass index (MD: -0.90 kg/m2; 95% CI: -1.67 to -0.14; p = 0.02) and systolic blood pressure (MD: -4.69 mmHg; 95% CI: -7.27 to -2.12; p < 0.001). In heart transplant recipients, the use of SGLT2 inhibitors was not associated with significant improvements in renal function or glycemic control and did not increase mortality or the incidence of urinary tract infections. However, SGLT2 inhibitor therapy was associated with significant reductions in body mass index and systolic blood pressure, suggesting a potential cardiometabolic benefit in this high-risk population. Given that hypertension and obesity are well-established cardiovascular risk factors and that hypertension, in particular, is a common complication among heart transplant recipients, these blood pressure and weight-lowering effects may be clinically meaningful. PROSPERO CRD420251057335.

A versatile colorimetric array sensor based on FeCu-based prussian blue analogue heterostructures for efficient discrimination of tetracycline antibiotics and rapid identification of urinary tract infection pathogens.