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.
Background: Urinary tract infections (UTIs) caused by uropathogenic E. coli (UPEC) pose a global health challenge, largely due to UPEC biofilms that drive persistent infections and antibiotic resistance.
Materials and methods: To explore the role of UPEC biofilms in antibiotic-resistant UTIs and summarize emerging therapeutic strategies, this study conducted a systematic review adhering to PRISMA guidelines and registered in PROSPERO (CRD420251040212). A structured search of PubMed, Google Scholar, Scopus, and Web of Science identified English-language studies published up to 2024, with 57 eligible studies selected after three-stage screening and analyzed via thematic synthesis.
Results: This study explored UPEC biofilms enhance resistance through extracellular matrix barriers, persister cell formation, efflux pump upregulation, and horizontal gene transfer; emerging therapies including bacteriophage therapy, quorum-sensing inhibitors, and nanoparticle-based drug delivery effectively target biofilms by penetration, signaling disruption, and improved drug efficacy. Additional approaches such as antibiofilm peptides, probiotics, and immunotherapy also demonstrate potential.
Conclusions: The UPEC biofilms are key to chronic UTIs, and novel targeted therapies offer promising solutions, but clinical validation, regulatory hurdles, and combination therapy optimization are critical for translation to clinical practice.
Background: Patients with renal injury are at increased risk of exacerbating kidney damage from contrast-enhanced radiological examinations. Therefore, a noninvasive and sustainable method for assessing renal function without contrast agents is imperative. This study evaluates the effectiveness of intravoxel incoherent motion-derived parameters in assessing renal function, comparing them to findings from single-photon emission computed tomography in rat models.
Materials and methods: This study involved 2 groups of rats. The first group underwent scans and biopsies on days 0, 3, 7, 10, and 14 after obstruction, whereas the second group was subjected to unilateral ureteral obstruction on the same days. Rats in the second group were also scanned on days 7 and 14 after obstruction release, with histopathological analyses performed on day 14 after recanalization. Parameters measured included the apparent diffusion coefficient, pure molecular diffusion, pseudodiffusion, perfusion fraction, and glomerular filtration rate (GFR) using both intravoxel incoherent motion and single-photon emission computed tomography. Data from each time point were analyzed using 1-way analysis of variance for multiple groups, and Pearson correlation analysis was used to evaluate the relationships between these parameters and GFR.
Results: Glomerular filtration rate showed positive correlations with apparent diffusion coefficient and pure molecular diffusion (p < 0.05). Additionally, cortical f demonstrated a significant positive correlation with GFR (r = 0.841, p < 0.05).
Conclusions: Intravoxel incoherent motion effectively captures changes in GFR during renal obstruction and recanalization. Notably, cortical f proves to be a promising indicator for assessing GFR.
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: 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.