Uro, Volume 6, Issue 3 (September 2026) – 8 articles

Purpose: Photoselective vaporization of the prostate (PVP) with the GreenLight laser is an established minimally invasive treatment for benign prostatic hyperplasia (BPH), yet its effects on voiding physiology remain incompletely characterized. Most prior studies rely on symptom scores and uroflowmetry as surrogate endpoints. This study evaluates the urodynamic mechanisms underlying clinical improvement following GreenLight PVP using paired pressure-flow studies. Methods: We performed a single-center retrospective review of patients who underwent GreenLight XPS PVP for BPH-related bladder outlet obstruction at a community hospital. Inclusion required complete pre- and postoperative pressure-flow urodynamic studies (UDS) and symptom assessments (IPSS). Key urodynamic parameters included maximum flow rate (Qmax), average flow rate (Qavg), detrusor pressure at maximum flow (Pdet@Qmax), maximum detrusor pressure (max Pdet), bladder outlet obstruction index (BOOI), and post-void residual (PVR). Postoperative UDS were performed at 12 months. Statistical analysis employed the Wilcoxon signed-rank test for continuous variables. Results: Of 98 total patients (mean age 71.3 years), paired uroflowmetry was available in 87 patients and pressure-flow data in 64. IPSS improved significantly from 17.1 to 9.5 at 12 months (p < 0.05). Qmax increased by 76%, from 6.25 to 11.0 mL/s (p < 0.05), and Qavg increased by 35%, from 4.0 to 5.4 mL/s (p < 0.05). Max Pdet decreased significantly from 84.8 to 61.2 cmH₂O (p < 0.05), and BOOI improved from 46.7 to 28.9 (p < 0.05). Pdet@Qmax and PVR did not change significantly. Conclusions: GreenLight PVP produces measurable restoration of voiding mechanics, evidenced by reduced peak detrusor pressures, improved outlet obstruction index, and enhanced urinary flow. These findings confirm that symptomatic improvement is underpinned by objective urodynamic de-obstruction. Larger prospective studies with longer follow-up are warranted. Full article

Background/Objectives: The objective of this study was to test the accuracy of two sound-based voided volume measurement applications compared to voided volume based on the measurement of pre- and post-void weight using a high-resolution scale. Methods: Seven male and four female volunteers participated. Male and female volunteers used the proudP and Healthy Bladder-Voiding Diary mobile apps, respectively, to measure sound-based voided volume (SVV). The difference between pre- and post-void weight was calculated and converted to mL to be the true voided volume (TVV) using a high-resolution scale. Pearson correlation coefficients were calculated, and paired t-tests were completed. Results: Eighty-one voids were recorded (42M/39F). The median male participant age was 25 years. Male SVV ranged from 42 to 790 mL, and TVV ranged from 61 to 880 mL. The mean difference was 39 mL (95% CI, 18–59 mL). SVV and TVV comparison revealed a strong correlation (r = 0.977, p < 0.0001). Bland–Altman analysis revealed a mean bias of 39 mL. The median female participant age was 25 years. Female SVV ranged from 32 to 440 mL, and TVV ranged from 20 to 682 mL. The mean difference was 55 mL (95% CI, 23–88 mL). SVV and TVV comparison revealed a correlation (r = 0.882, p < 0.0001). Bland–Altman analysis demonstrated a mean bias of 55 mL. Conclusions: In this pilot study, we found that the male and female apps have a strong correlation to true voided volume (male > female app) and can be used by patients to track voided volume at home. The male app accurately measures voided volume within 60 mL from the TVV; however, the female app is less accurate. These preliminary findings warrant validation in larger prospective cohorts. Full article

Background: Celiac disease (CD) is a systemic immune-mediated enteropathy with a broad spectrum of extraintestinal manifestations driven by aberrant mucosal IgA responses and increased intestinal permeability. These same mechanisms provide a compelling biological rationale for urinary tract involvement. The aim of this systematic review was to assess whether adults with CD carry an elevated risk of IgAN, UTI, or IC/BPS compared with adults without CD. Methods: A PRISMA 2020-compliant systematic review was conducted (PROSPERO: CRD420261358537). PubMed and Scopus were searched up to April 2026. Eligible studies enrolled adults (≥18 years) with confirmed CD, reported a urinary outcome, and included a comparator group. Risk of bias was assessed using the Newcastle–Ottawa Scale and Mendelian Randomization quality criteria. Results: Fifteen studies (1987–2025) were included. For IgAN (n = 13), a register-based cohort showed an over 18-fold elevated risk in adults with biopsy-confirmed CD (adj. HR: 18.98; 95%CI: 2.29–157.63), independently corroborated by Mendelian Randomization (OR: 1.44; 95%CI: 1.17–1.78). Early cross-sectional AGA studies reflect non-specific IgA dysregulation, not true CD autoimmunity. For UTI (n = 1), no significant association was identified in a single large registry study. For IC/BPS (n = 1), no clinical observational evidence exists and genetic causal analysis found no association. Conclusions: CD is consistently associated with elevated IgAN risk across independent study designs, supporting systematic CD screening in IgAN patients and prompt GFD initiation. For UTI and IC/BPS, adequately designed prospective studies are needed. Full article

Background/Objectives: To evaluate the discrepancies between the International Prostate Symptom Score (IPSS) and objective measures—uroflowmetry (Qmax) and post-void residual (PVR) volume—in men with lower urinary tract symptoms (LUTS), and to assess the implications for diagnosis and treatment planning. Methods: This retrospective study analyzed data from 414 men across three urology clinics who completed both IPSS and uroflowmetry between April 2023 and September 2024. IPSS total and subscores were categorized by severity and compared with Qmax (<15 vs. ≥15 mL/s) and PVR (<250 vs. ≥250 mL). Two exploratory discordance patterns were defined: a ‘bother-dominant’ pattern (moderate-to-severe IPSS with normal Qmax or PVR) and an ‘unrecognized voiding dysfunction’ pattern (mild IPSS with abnormal Qmax or PVR). Results: Among patients with severe total IPSSs, 8.7% had Qmax ≥ 15 mL/s, consistent with a ‘bother-dominant’ pattern, and 8.7% of those with mild scores had Qmax < 15 mL/s, consistent with an ‘unrecognized voiding dysfunction’ pattern. When moderate scores were included, the ‘bother-dominant’ pattern was observed in 27.8% and the unrecognized voiding dysfunction pattern in 36.0%. For PVR, 40.1% of patients with severe IPSSs had PVR < 250 mL (‘bother-dominant’ pattern), while the unrecognized voiding dysfunction pattern with elevated PVR was rare (≤1.3%). Discrepancies were also observed across voiding and storage subscores and individual items, such as incomplete emptying and weak stream. Conclusions: There is frequent discordance between subjective symptom severity and objective urodynamic findings in men with LUTS. Sole reliance on IPSS may lead to misclassification and inappropriate treatment. Incorporating Qmax and PVR into routine evaluation may enhance diagnostic accuracy and support more personalized management strategies. Full article

Coital urinary incontinence is a frequently underdiagnosed manifestation of female pelvic floor dysfunction, characterized by involuntary urine leakage during sexual activity, particularly during vaginal penetration or orgasm. Although interest in this condition has increased in recent years, it remains insufficiently investigated in clinical practice and is often underreported by patients because of stigma, emotional distress, and the negative impact on intimate relationships and quality of life. Current evidence supports the existence of distinct pathophysiological mechanisms depending on the timing of urinary leakage. Leakage occurring during vaginal penetration is more commonly associated with stress urinary incontinence, urethral hypermobility, and pelvic support defects, whereas orgasm-associated urinary incontinence appears to be more closely related to detrusor overactivity and complex pelvic neurophysiological mechanisms. Hormonal changes associated with the peri- and postmenopausal period may further contribute to symptom progression through alterations in urethral and vaginal trophicity, local vascularization, and pelvic neuromuscular function. Clinical evaluation remains challenging because many affected women do not voluntarily report symptoms due to embarrassment or social stigma, therefore it requires targeted questioning regarding urinary leakage during sexual activity, associated lower urinary tract symptoms, and the impact on female sexual health. Therapeutic management should be individualized and tailored to the predominant underlying mechanisms, including pelvic floor rehabilitation, behavioral interventions, pharmacological treatment, local hormonal therapy, and surgical management of stress urinary incontinence or pelvic support defects. Minimally invasive and regenerative therapies, such as vaginal laser therapy, platelet-rich plasma, cellular therapies, and neuromodulation, represent promising therapeutic approaches. Greater awareness and proactive screening during urogynecological evaluation are essential for improving diagnosis, individualized treatment, sexual health, and overall quality of life in affected women. Full article

Background: High-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) is an established salvage therapy for relapsed or refractory (R/R) germ cell tumors (GCTs). Methods: We conducted a retrospective analysis of 9 patients (23–41 years of age) with relapsed/refractory (R/R) GCTs treated according to the Swedish–Norwegian Testicular Cancer Group Clinical Protocol (SWENOTECA), at the Specialized Hospital for Active Treatment of Hematological Diseases (SHATHD) in Sofia, Bulgaria. The study evaluates the efficacy and safety of HDCT followed by ASCT in R/R GCTs eligible for second-line consolidation. The cohort was predominantly high-risk, with 77.7% of patients exhibiting stable or progressive disease (SD/PD) after first-line platinum therapy. Response was assessed via RECIST 1.1 criteria and tumor marker monitoring. Results: Median OS and PFS were 8.4 and 5.9 months, respectively. While the ORR post-ASCT was 33.3% (all CR), the 2-year survival plateau (33.3%) suggests curative potential in a subset of patients. Notably, there was no treatment-related mortality (TRM). Conclusions: Tandem HDCT is a feasible salvage strategy with manageable toxicity and no TRM in this small, heavily pre-treated cohort. Although efficacy results are exploratory due to the limited number of patients, the observed long-term remissions confirm the curative potential of this standard-of-care consolidation in a real-world clinical setting. Full article

Background: Retrograde intrarenal surgery (RIRS) is a well-established minimally invasive technique for the management of renal stones. However, intraoperative physiological and anesthetic events during the procedure remain poorly characterized, particularly in the context of newer technologies such as suction-assisted systems. Objective: The objective of this study is to evaluate the occurrence of intraoperative anesthetic and physiological adverse events during suction-assisted RIRS and to assess its safety profile. Methods: We conducted a prospective, single-center observational sub-analysis of the “Trifecta factors in ureteroscopy” project. A consecutive cohort of 30 patients undergoing RIRS with suction ureteral access sheaths (sUAS) between August 2025 and January 2026 was analyzed. Baseline demographics, stone characteristics, and intraoperative anesthetic parameters—including airway pressure, Bispectral Index (BIS), and hemodynamic events—were prospectively recorded. Primary endpoints included intraoperative fever, sustained tachycardia, blood pressure alterations, and anesthetic complications. Results: The cohort had a mean age of 56.4 years with an equal gender distribution. Mean stone size was 12.9 mm, and mean operative time was 50.3 min. Intraoperative monitoring demonstrated stable anesthetic conditions, with a mean airway pressure of 16.3 cmH₂O and a mean BIS of 42.6. No major anesthetic complications or significant blood pressure fluctuations were observed. Minor intraoperative events included fever in 10% of cases and sustained tachycardia in 6.7%. No cases of intraoperative anesthetic instability were recorded. Conclusions: Within this descriptive cohort, suction-assisted RIRS under general anesthesia demonstrated a favorable safety profile with stable intraoperative parameters, though larger comparative studies are required to confirm these preliminary findings. Full article

Objective: Quantib^® Prostate is a commercially available machine learning software (MLS) used for prostate magnetic resonance imaging (MRI), approved by the Food and Drug Administration (FDA) and Conformité Européenne (CE). We aimed to assess the agreement between biparametric MRI (bpMRI) interpretations produced by radiologists and by Quantib^® alone. Material and Methods: This single-centre, retrospective, and observational study included 188 bpMRI scans from the Innlandet Hospital Trust, Norway. Radiologists’ Prostate Imaging Reporting and Data System (PI-RADS) scores were compared with scores produced by the Quantib^® Prostate PI-RADS, which was used as an autonomous software. Additionally, for exploratory purposes, the PI-RADS scores were compared with biopsy findings, using the radiologist’s scorings to determine biopsy indications. Results: For PI-RADS scores generated by radiologists vs. those produced by Quantib^® Prostate, the weighted kappa was 0.49 (95% CI: 0.37–0.59), and 46% of the PI-RADS scores differed by at least one unit. In the sample, 125 men (66%) had a prostate biopsy, and for male patients with PI-RADS scores of 4–5, the probability of detecting cancer grades 2–5 via biopsies was 64% (95% CI: 56–71) for radiologists and 58% (95% CI: 54–62) for Quantib^® Prostate. The main limitations of this study are the retrospective, single-centre design, the small sample size, the use of Quantib^® Prostate in an autonomous manner, and verification bias, as the biopsy decisions were based solely on PI-RADS scoring by radiologists. Conclusions: We identified inter-rater variability between PI-RADS scores generated by Quantib^® Prostate and radiologists’ assessments, and the agreement between the two scoring groups is moderate. Our results suggest that Quantib^® Prostate requires further clinical comparative studies before it is used in clinical routines. Full article