Benign prostatic hyperplasia (BPH) is one of the most frequently diagnosed benign disorders that cause dysuria in middle-aged and elderly men. Some patients with BPH have relatively small prostates (referred to as small-volume BPH) but still experience the lower urinary tract infection. Medication treatment is typically not successful in these patients. In addition, their pathophysiologic pathways deviate from those previously observed. Furthermore, as there is no accepted protocol for the diagnosis and treatment of small-volume BPH, patients can experience great difficulties in managing surgical complications such as bladder neck contracture. Thus, we reviewed the features of small-volume prostates, preoperative assessment, surgical technique, and management of complications.

Background: The prevalence of benign prostatic hyperplasia (BPH) in older men increases with age, beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years. Surgical procedures such as holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are the preferred treatments for BPH. Nevertheless, there is disagreement regarding the most efficient and safe treatment for BPH. The objective of this meta-analysis was to assess the efficacy and safety of HoLEP and TURP based on existing evidence.

Materials and methods: This meta-analysis was performed in accordance with the PRISMA guidelines. In February 2023, a literature review was conducted using PubMed, ScienceDirect, and the Cochrane Library, and the meta-analysis was performed using RevMan V.5.4.

Results: A total of 656 patients underwent HoLEP, and 653 patients underwent TURP. There was no statistically significant difference in the International Prostate Symptom Score at 1 month or at 3, 6, 18, 24, and 36 months; the HoLEP group showed a significant difference at 12 months. The pooled data from the maximum urinary flow rate at 1-12 months revealed no significant findings, but the TURP group showed significant results at 24 months. Meanwhile, the HoLEP group showed significant postvoid residual results. There was no significant difference in the quality of life between the groups. Patients who underwent HoLEP had shorter hospital stay and catheter usage period and had lower hemoglobin drop. The operating time was shorter in the TURP group. The difference in specimen weight between the 2 groups was not statistically significant. The overall complications were similar in both groups, but the HoLEP group received significantly fewer blood transfusions.

Conclusions: Holmium laser enucleation of the prostate demonstrated excellent efficacy and safety, with fewer hematological changes and complications; however, TURP had a shorter operating time.

Background: We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization (PVP) versus holmium laser enucleation of the prostate (HoLEP).

Methods: Databases (PubMed, Embase, Cochrane Library, Chinese CBM, and CNKI) were searched for eligible studies evaluating HoLEP or PVP outcomes, published until May 2022. We analyzed the incidence of relative complications and postoperative outcomes, including the international prostate symptom score, maximum flow rate (Qmax), postvoid residual urine volume, quality of life index, and prostate-specific antigen levels.

Results: Eleven studies involving 4763 patients were included in this meta-analysis. The significant differences in postoperative Qmax at 1 month (mean difference [MD], 3.31, 95% confidence interval [CI], 0.45-6.16, p = 0.02, I², 92%), 3 months (MD, 2.78, 95% CI, 0.53-5.02, p = 0.02, I², 89%), 6 months (MD, 2.13, 95% CI, 1.11-3.15, p < 0.0001, I², 87%), and 12 months (MD, 3.98, 95% CI, 2.06-5.89, p < 0.0001, I², 58%) further confirmed unique advantage of HoLEP over PVP. We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups (odds ratio, 0.05, 95% CI, 0.01 to 0.28, p = 0.0005).

Conclusions: Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores, quality of life index, postvoid residual urine volumes, prostate-specific antigen levels, perioperative factors, and total complication rates. Compared with PVP, HoLEP had a greater Qmax 1 year postoperatively, decreased energy expenditure, and fewer high-grade complications. These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.

Background: Bipolar transurethral enucleation of the prostate (B-TUEP) is a well-established surgical treatment for benign prostatic hyperplasia (BPH); however, its efficacy may vary depending on patient characteristics. Magnetic resonance imaging (MRI) with radiomics analysis can offer comprehensive and quantitative information about prostate characteristics that may relate to surgical outcomes. This study aimed to explore the value of MRI and radiomics analysis in predicting the short-term efficacy of B-TUEP for BPH.

Materials and methods: A total of 137 patients with BPH who underwent B-TUEP at 2 institutions were included. Radiological features were measured in the MRIs, and the radiomics score was developed from 1702 radiomics features extracted from the prostate and transitional zone regions of interest. Three prediction models were developed and validated based on clinical-radiological features, radiomic features, and their combinations. The models were evaluated using the area under the receiver operating characteristic curve, calibration curve, and decision curve analysis.

Results: The combination model exhibited the highest area under curve in both the training set (0.838) and the external validation set (0.802), indicating superior predictive performance and robustness. Furthermore, the combination model demonstrated good calibration (p > 0.05) and optimal clinical utility. The combination model indicated that a higher maximum urine flow rate, lower transitional zone index, and higher radiomics score were associated with an increased risk of poor efficacy.

Conclusions: Magnetic resonance imaging with radiomic analysis can offer valuable insights for predicting the short-term efficacy of B-TUEP in patients with BPH. A combination model based on clinical and radiomics features can assist urologists in making more precise clinical decisions.

Immunotherapy has become a standard treatment for patients with advanced urothelial carcinoma, and neoadjuvant immunotherapy is currently being extensively explored. This review highlights the initial findings and key clinical therapeutic insights on immune checkpoint inhibitors in the early treatment of muscle-invasive bladder cancer across diverse patient populations. Most available literature consists of clinical investigations involving small sample, single-arm phase II trials, with the primary endpoint being the pathologic complete response rate. Early results of immune checkpoint inhibitors in the neoadjuvant treatment of bladder cancer have demonstrated promising efficacy. However, these findings require confirmation in large phase III clinical trials, with particular emphasis on long-term survival benefits and identifying patients who respond to treatment.

Background: Radiomics refers to the conversion of medical images into high-throughput, quantifiable data to analyze disease patterns, aid decision-making, and predict prognosis. Radiogenomics is an extension of radiomics and involves a combination of conventional radiomics techniques with molecular analysis in the form of genomic and transcriptomic data. In the field of bladder cancer, studies have investigated the development, implementation, and efficacy of radiomic and radiogenomic nomograms in predicting tumor grade, gene expression, and oncological outcomes, with variable results. We aimed to perform a systematic review of the current literature to investigate the development of a radiomics-based nomogram to predict oncological outcomes in bladder cancer.

Materials and methods: The Medline, EMBASE, and Web of Science databases were searched up to February 17, 2023. Gray literature was also searched to further identify other suitable publications. Quality assessment of the included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 and Radiomics Quality Score.

Results: Radiogenomic nomograms generally had good performance in predicting the primary outcome across the included studies. The median area under the curve, sensitivity, and specificity across the included studies were 0.83 (0.63-0.973), 0.813, and 0.815, respectively, in the training set and 0.75 (0.702-0.838), 0.723, and 0.652, respectively, in the validation set.

Conclusions: Several studies have demonstrated the predictive potential of radiomic and radiogenomic models in advanced pelvic oncology. Further large-scale studies in a prospective setting are required to further validate results and allow generalized use in modern medicine.

Background: Isolinderalactone (ILL), extracted from the dried tubers of Linderae aggregate, has multiple functions, such as antioxidation, antitumor, and anti-infection effects. However, there have been few studies on ILL's antitumor role and no reports on its role in bladder cancer (BC).

Materials and methods: Human BC cell lines T24 and EJ-1 were treated with different concentrations of ILL (0, 10, 20, 50, 100, 200, 400, 600, 800, and 1000 μmol/L), and the cell proliferation inhibition rate was analyzed using the CCK-8 assay. The effect of ILL on T24 and EJ-1 cell cycle inhibition and apoptosis was examined using flow cytometry. Immunoblotting was used to detect the levels of apoptosis-related proteins, BAX, BAK1, and CYCS, in BC cells of the control and ILL-treated groups, and quantitative PCR experiments were performed to detect the apoptosis-related gene expression of CASP10, CYCS, BAX, BCL-2, CASP8, and BAK1. T24 and EJ-1 tumor-bearing mouse models were established and divided into vehicle control, low-dose (10 mg/kg) and high-dose (20 mg/kg) groups, with 5 mice in each group. Hematoxylin and eosin staining and immunohistochemistry were used to detect changes in apoptosis-related proteins in vivo.

Results: The CCK-8 assay showed that in vitro, ILL significantly inhibited the proliferation of the T24 and EJ-1 BC cell lines. Flow cytometry and immunoblotting results showed that ILL increased mitochondrial permeability by upregulating proapoptotic proteins BAK1 and BAX, promoting CYCS release and significantly inducing cell cycle arrest at G0/G1 phase. In vivo, on day 25 of administration, tumor inhibition rates in T24 and EJ-1 tumor-bearing mice were up to 75.24% and 47.43%, respectively, in the ILL high-dose-treated and 71.58% and 43.89%, respectively, in the ILL low-dose-treated groups.

Conclusions: Isolinderalactone controls BC progression by inducing apoptosis, suggesting that ILL may be an effective drug for the treatment of BC.

Objectives: Spinal cord injury (SCI) is one of the most debilitating and expensive traumatic conditions. Chronic complications after SCI have a particularly negative impact on patients’ functional independence and quality of life. Urodynamic study (UDS) provides a quantitative assessment of lower urinary tract function in these patients. In many fields, animal models are considered a precursor to clinical trials, so research using laboratory animals play a major role in knowledge acquisition.

Materials and methods: Twelve female Wistar rats (13 weeks old, 220-270 g) were divided randomly into 2 groups: sham or SCI. The sham-operated group underwent a laminectomy at T9-T10 without any spinal cord damage, while the SCI group underwent a complete transection at the T9-T10 vertebral level. We performed cystometry in all animals at the end of the fourth week. In this article, we visualize all procedures for catheter implementation and UDS in animals for the first time at Tabriz University of Medical Sciences, Iran, using a locally developed animal UDS device.

Results: The UDS results showed that the bladders in the SCI group were overactive and that peak and baseline pressures increased significantly in rats with SCI when compared with the sham group (p < 0.05 for all). Conversely, significant reductions in bladder compliance and intercontraction interval were observed in the SCI group (p < 0.05 for both).

Conclusions: This comprehensive visual report will be very useful to all researchers in the field of urology. Furthermore, the measurable variables of the UDS device have been described in this study.

Background: This study aimed to evaluate the impact of the clock drawing test (CDT) on postoperative delirium and compare the abilities of the mini-cognitive (Mini-Cog) test and the CDT for predicting postoperative delirium after major urological cancer surgery.

Materials and methods: In this single-center retrospective observational study, we collected the medical records of patients who underwent major urologic cancer surgery and preoperative cognitive screening based on the Mini-Cog test consisting of the CDT and the 3-word recall task at our department in 2020-2021 (n = 387). Univariate and multivariate logistic regression analyses were used to identify the clinical risk factors for postoperative delirium. We also compared the ability of the CDT alone and the Mini-Cog test consisting of the CDT and 3-word recall task to predict postoperative delirium.

Results: A total of 117 patients (30%) had abnormal CDT results. Postoperative delirium occurred in 29 patients (7%). On multivariate analysis, American Society of Anesthesiologists physical status ≥3 (odds ratio [OR], 5.0; p = 0.01), abnormal CDT (OR, 4.8; p < 0.001), preoperative benzodiazepine use (OR, 4.9; p < 0.001), and operative time ≥237 minutes (OR, 3.0; p = 0.01) were independent risk factors for postoperative delirium. The area under the curve for predicting postoperative delirium was 0.709 for CDT alone and 0.743 for the Mini-Cog test. No significant intergroup difference was observed (p = 0.43).

Conclusions: The CDT served as a formal but simple tool with adequate predictive power to identify the risk of postoperative delirium among patients undergoing major urological cancer surgery. Effective screening using the CDT might help provide optimal urological care for older patients.

Although suprapubic cystotomy for catheter insertion is commonly performed, complications can be associated with serious morbidity. This case describes delayed recognition of a transperitoneal suprapubic catheter (SPC) traversing the small bowel mesentery and causing a closed loop obstruction of the caecum 7 years after SPC insertion. There are very few cases in the literature of SPC causing mesenteric perforation and to the best of our knowledge, this is the first reported case causing subsequent obstruction of the caecum and the longest delay of 7 years between SPC insertion and manifestation of bowel obstruction.