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Advances in the Diagnosis, Prognosis, and Management of Urinary Disease
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Advances in the Diagnosis, Prognosis, and Management of Urinary Disease

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 8615

Special Issue Editors

Prof. Dr. Nicola Longo

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Guest Editor
Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
Interests: prostate cancer; kidney cancer; bladder cancer; advanced imaging for urologic cancer
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Massimiliano Creta

E-Mail Website
Guest Editor
Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
Interests: bladder cancer; radical cystectomty; radical nephroureterectomy; transurethral resection of bladder tumor; upper urinary tract urothelian carcinoma
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The urinary system plays a vital role in maintaining the body's internal equilibrium by regulating fluid balance, electrolytes and waste excretion. However, when dysfunction occurs within this intricate system, it can lead to a myriad of disorders with varying degrees of severity.

Recent studies have shown the development of newer screening, diagnostic assays that can be very precise in discovering and discriminating the characteristics of many urological conditions. New advanced treatment approaches and therapeutic modalities for those diseases have also been developed, while several others are currently being evaluated in preclinical or clinical trials.

In this Special Issue, we delve into the latest advancements, challenges and emerging trends in the diagnosis, treatment and management of urinary diseases, from common conditions such as urinary tract infections and kidney stones to more complex disorders such as kidney, bladder and prostate cancer.

We prioritize high-quality original studies, encourage multidisciplinary works and welcome well-designed meta-analyses and reviews. Articles about malignant diseases such as kidney cancer, bladder cancer and prostate cancer are especially welcome.

Prof. Dr. Nicola Longo
Prof. Dr. Massimiliano Creta
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • urinary disease
  • diagnosis
  • prognosis
  • kidney disease
  • prostate disease
  • malignant diseases like kidney cancer, bladder cancer and prostate cancer

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Published Papers (7 papers)

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12 pages, 628 KiB  
Article
Impact of Nerve-Sparing Techniques on Prostate-Specific Antigen Persistence Following Robot-Assisted Radical Prostatectomy: A Multivariable Analysis of Clinical and Pathological Predictors
by Lorenzo Spirito, Carmine Sciorio, Lorenzo Romano, Antonio Di Girolamo, Antonio Ruffo, Giuseppe Romeo, Felice Crocetto, Luigi Napolitano, Marco Stizzo, Francesco Bottone, Carmelo Quattrone and Vittorio Imperatore
Diagnostics 2025, 15(8), 987; https://doi.org/10.3390/diagnostics15080987 - 13 Apr 2025
Viewed by 361
Abstract
Background/Objectives: Prostate-specific antigen (PSA) persistence, defined as a postoperative PSA level ≥ 0.1 ng/mL measured within 4–8 weeks after radical prostatectomy (RP), predicts biochemical recurrence (BCR) and adverse oncological outcomes. The influence of nerve-sparing (NS) surgical techniques on PSA persistence remains debated, especially [...] Read more.
Background/Objectives: Prostate-specific antigen (PSA) persistence, defined as a postoperative PSA level ≥ 0.1 ng/mL measured within 4–8 weeks after radical prostatectomy (RP), predicts biochemical recurrence (BCR) and adverse oncological outcomes. The influence of nerve-sparing (NS) surgical techniques on PSA persistence remains debated, especially among patients with high-risk pathological features. This study aimed to evaluate the impact of NS techniques on PSA persistence following robot-assisted radical prostatectomy (RARP), considering tumor characteristics, surgical parameters, and patient-specific factors. Methods: A retrospective cohort analysis was performed on 779 patients who underwent RARP at a single institution between January 2002 and December 2015. The inclusion criteria consisted of histologically confirmed prostate cancer with available preoperative and postoperative data, including PSA measurements taken 4–8 weeks after surgery. PSA persistence served as the primary outcome. Statistical analyses included descriptive statistics, univariate and multivariable logistic regression models to identify predictors of PSA persistence, and Spearman’s correlation along with the Kruskal–Wallis H test to evaluate associations. Results: Of the 779 patients included, 55% underwent NS surgery (51% unilateral, 49% bilateral). The mean preoperative PSA was 11.85 ng/mL (SD: 7.63), while the mean postoperative PSA was 0.70 ng/mL (SD: 4.42). An elevated postoperative PSA was associated with a larger tumor size (r = 0.1285, p < 0.001), advanced pathological stages (χ2 = 45.10, p = 3.79 × 10−9), and higher Gleason scores (χ2 = 24.74, p = 1.57 × 10−4). NS surgery correlated with a lower postoperative PSA (mean: 0.20 ng/mL) compared to non-NS procedures (mean: 0.65 ng/mL), with slight differences between unilateral (mean: 0.30 ng/mL) and bilateral (mean: 0.35 ng/mL) NS approaches. Multivariable regression analysis identified advanced pathological stage (coefficient = 1.16, p = 0.04) as an independent predictor of PSA persistence, while NS techniques had no significant independent effect (coefficient = −0.01, p = 0.99). Conclusions: Nerve-sparing surgical techniques do not independently predict PSA persistence after RARP when adjusting for tumor-related factors and confounders. Advanced pathological stage, particularly stage pT3b, primarily determines PSA persistence. These findings highlight the necessity of personalized surgical planning informed by preoperative imaging and patient-centered decision making to optimize oncological and functional outcomes. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Prognosis, and Management of Urinary Disease)
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21 pages, 1137 KiB  
Article
CDC20 and CCNB1 Overexpression as Prognostic Markers in Bladder Cancer
by Hatice Sevim Nalkiran, Ilknur Biri, Ihsan Nalkiran, Hakki Uzun, Sumeyye Durur and Recep Bedir
Diagnostics 2025, 15(1), 59; https://doi.org/10.3390/diagnostics15010059 - 29 Dec 2024
Cited by 1 | Viewed by 896
Abstract
Background: Bladder cancer (BC) is one of the ten most common cancers worldwide, with a high recurrence rate and significant variation in clinical outcomes based on tumor grade and stage. This study aimed to investigate the gene expression profiles at different cancer stages [...] Read more.
Background: Bladder cancer (BC) is one of the ten most common cancers worldwide, with a high recurrence rate and significant variation in clinical outcomes based on tumor grade and stage. This study aimed to investigate the gene expression profiles at different cancer stages to assess their potential prognostic value. Methods: RNA was extracted from paraffin-embedded BC tissues and the gene expression levels of CDC20 and CCNB1 were analyzed using qRT-PCR. A total of 54 BC patient samples were included in the analysis and categorized into low-grade (LG) (n = 23) and high-grade (HG) (n = 31) tumors, as well as stages pTa, pT1, and pT2. Results: CDC20 gene expression was significantly higher in the HG group (mean fold-change: 16.1) compared to the LG group (mean fold-change: 10.54), indicating a significant association with tumor grade (p = 0.039). However, no significant differences were observed in CDC20 expression across the cancer stages. For CCNB1, while gene expression was significantly elevated in higher-stage tumors (pT2 vs. pTa; p = 0.038), no significant association was found between CCNB1 expression and tumor grade. Survival analysis revealed that increased CCNB1 expression and advanced cancer stage were associated with poorer overall survival, whereas no significant impact of CDC20 expression or tumor grade on survival was observed. Correlation analysis indicated a positive relationship between CDC20 expression and tumor grade (r = 0.284, p = 0.038) and between CCNB1 expression and tumor stage (r = 0.301, p = 0.027). Conclusions: Our findings suggest that CDC20 overexpression is linked to higher tumor grades, while CCNB1 overexpression is associated with more advanced cancer stages in BC. These results underscore the potential utility of CDC20 and CCNB1 as biomarkers for tumor prognosis and as therapeutic targets. Further studies with larger cohorts are needed to validate these findings and better understand the molecular mechanisms driving BC progression. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Prognosis, and Management of Urinary Disease)
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12 pages, 8589 KiB  
Article
Is Immunohistochemical Galectin-3 Expression Associated with the Epithelial–Mesenchymal Transition in High- and Low-Grade Invasive Urothelial Carcinomas of the Bladder?
by Merve Cin, Ayşenur Akyıldız İğdem, Sibel Bektaş, Özgecan Gündoğar, Selçuk Cin, Neslihan Komut and Buğra Çetin
Diagnostics 2024, 14(20), 2270; https://doi.org/10.3390/diagnostics14202270 - 12 Oct 2024
Viewed by 1059
Abstract
Background/Objectives: Bladder cancer, predominantly urothelial carcinoma, is an important malignancy of the urinary system. Despite the same histologic grade and stage, some patients seem to have a worse prognosis. In this context, the epithelial–mesenchymal transition (EMT), characterized by the loss of E-cadherin [...] Read more.
Background/Objectives: Bladder cancer, predominantly urothelial carcinoma, is an important malignancy of the urinary system. Despite the same histologic grade and stage, some patients seem to have a worse prognosis. In this context, the epithelial–mesenchymal transition (EMT), characterized by the loss of E-cadherin and gain of vimentin expression, is an important process in tumor progression. Galectin-3, a lactose-binding protein involved in various cellular processes, has been associated with increased tumor cell migration, invasion, and treatment resistance. Methods: In this study, 223 bladder cancer cases were examined, and E-cadherin, vimentin, and galectin-3 expression was evaluated by immunohistochemical staining in tumor budding areas and invasive components. These markers were also correlated with clinicopathological parameters, including tumor grade and stage. Results: The results indicated a significant decrease in E-cadherin expression and an increase in vimentin staining in higher-grade and higher-stage tumors, supporting EMT involvement. Galectin-3 expression was notably higher in T1 high-grade tumors but decreased in T2 stage tumors. Despite this, no significant correlation was found between galectin-3 and E-cadherin or vimentin, suggesting a complex role of galectin-3 in EMT. Conclusions: High galectin-3 expression in T1 high-grade tumors highlights its potential role in early tumor progression and as a therapeutic target. However, the decrease in its expression in advanced stages underscores the need for further research to understand its multifaceted involvement in bladder cancer. These findings suggest that while galectin-3 may contribute to the EMT and early tumor progression, its exact role and potential as a therapeutic target require more detailed investigation. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Prognosis, and Management of Urinary Disease)
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9 pages, 324 KiB  
Communication
Internal Overview of Prostatic Cancer Cases and Quality of BRCA1 and BRCA2 NGS Data from the FFPE Tissue
by Enrica Antolini, Alessandra Filosa, Matteo Santoni, Elena Antaldi, Elisa Bartoli, Lidia Sierchio, Federica Giantomassi, Alessandra Mandolesi and Gaia Goteri
Diagnostics 2024, 14(18), 2067; https://doi.org/10.3390/diagnostics14182067 - 18 Sep 2024
Cited by 1 | Viewed by 1222
Abstract
Background: Comprehensive genomic profiling (CGP) has gained an important role in patients with advanced prostate cancer following the introduction of PARP inhibitors in daily clinical practice. Here, we report an overview of CGP results, specifically of BRCA1 and BRCA2 HRD-repair system genes, from [...] Read more.
Background: Comprehensive genomic profiling (CGP) has gained an important role in patients with advanced prostate cancer following the introduction of PARP inhibitors in daily clinical practice. Here, we report an overview of CGP results, specifically of BRCA1 and BRCA2 HRD-repair system genes, from patients with prostate cancer analyzed in our institution, and we compare our results with those available from more recent scientific literature. Methods: The study cohort consisted of 70 patients. Somatic DNA was extracted from Formalin-Fixed Paraffin-Embedded (FFPE) tissue using a MagCore Genomic DNA FFPE One-Step Kit for MagCore System. The DNA was quantified by EasyPGX® Real-Time qPCR and EasyPGX® Analysis Software (version 4.0.13). Tissue somatic DNA libraries were prepared with Myriapod® NGS BRCA1-2 panel-NG035 and sequenced in a Mi-Seq® System. The sequence alignment in hg19 and the variant calling were performed using Myriapod® NGS Data Analysis Software version 5.0.8 NG900-SW 5.0.8 with a software detection limit (LoD) of 95%. Variants with a coverage of 500 and VAF% ≥ 5 were evaluated. Results: Tumor tissue NGS was unsuccessful in 46/70 patients (66%). Mutations of the BRCA2 gene were detected in 4 of the samples: (1) BRCA2 ex10 c.1244A>G p.His415Arg VAF = 51.03%; (2) BRCA2 ex11 c.5946delT p.Ser1982fs VAF = 72.1%; (3) BRCA2 ex11 c.3302A>G p.His1101Arg VAF = 52.9%; and (4) BRCA2 ex11 c.3195_3198delTAAT p.Asn1066fs VAF = 51.1%. Conclusions: The results from our internal overview seem to support the data and to confirm the performance of the technical issues reported in the literature. Considering the advanced age of our patients, with 84% of men over the age of 65, the application of alternative and less invasive procedures such as liquid biopsy, could be a more suitable solution for some cases. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Prognosis, and Management of Urinary Disease)
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15 pages, 1907 KiB  
Article
Persisting Hypercalcemia and Hyperparathyroidism after Kidney Transplantation Have a Negative Impact on Graft and Patient Survival
by Hannes Egli, Naomi Burla, Eva Breuer, Camilla Baron, Kerstin Hübel, Olivier de Rougemont, Harald Seeger and Diana Vetter
Diagnostics 2024, 14(13), 1358; https://doi.org/10.3390/diagnostics14131358 - 26 Jun 2024
Cited by 1 | Viewed by 2024
Abstract
Hyperparathyroidism (HPT) with hypercalcemia, often deemed irreversible and detrimental to graft survival post-kidney transplantation (KT), prompts pre-transplant parathyroidectomy in hypercalcemic patients. In this retrospective analysis of 1212 kidney transplant recipients (KTRs) between 2006 and 2019, the incidence and effect of persistent HPT and [...] Read more.
Hyperparathyroidism (HPT) with hypercalcemia, often deemed irreversible and detrimental to graft survival post-kidney transplantation (KT), prompts pre-transplant parathyroidectomy in hypercalcemic patients. In this retrospective analysis of 1212 kidney transplant recipients (KTRs) between 2006 and 2019, the incidence and effect of persistent HPT and hypercalcemia on graft and patient survival, and risk factors for persistence were analyzed until 60 months of follow up (FU). At KT, 5.7% (n = 69) had no HPT, 32.7% (n = 396) had HPT without hypercalcemia and 37.0% (n = 448) had HPT with hypercalcemia. At 2 years FU, 26.4% (n = 320) of patients had no HPT and 6% (n = 73) had HPT with hypercalcemia. Dialysis and dialysis duration were linked to HPT development, while dialysis, KT waiting time and donor type correlated with persisting hypercalcemia after KT. KTRs with normalized PTH and recovered hypercalcemia had improved death-censored graft survival (p < 0.001) and overall patient survival (p < 0.001). HPT with hypercalcemia is frequent at time of KT with normalization of PTH and calcium in a substantial proportion of patients after a KT. These findings question the routine pre-KT parathyroidectomy for suspected parathyroid autonomy. Persisting HPT, especially with hypercalcemia, adversely affects graft and patient survival, suggesting the need for more aggressive treatment of HPT, especially in cases of persisting hypercalcemia. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Prognosis, and Management of Urinary Disease)
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16 pages, 2510 KiB  
Article
A Pilot Comparative Study between Creatinine- and Cystatin-C-Based Equations to Estimate GFR and Kidney Ultrasound Percentiles in Children with Congenital Anomalies of the Kidney and Urinary Tract
by Ruxandra Maria Steflea, Ramona Stroescu, Mihai Gafencu, Emil Robert Stoicescu, Raluca Isac, Ioana-Cristina Olariu, Andrada Mara Micsescu-Olah, Septimiu Radu Susa, Mircea Murariu and Gabriela Doros
Diagnostics 2024, 14(10), 994; https://doi.org/10.3390/diagnostics14100994 - 10 May 2024
Viewed by 1921
Abstract
Congenital anomalies affecting the kidneys present significant challenges in pediatric nephrology, needing precise methods for assessing renal function and guiding therapeutic intervention. Bedside Schwartz formula with the cystatin-C-based Full Age Spectrum formula and Chronic Kidney Disease in Children (CKiD) U 25 formula used [...] Read more.
Congenital anomalies affecting the kidneys present significant challenges in pediatric nephrology, needing precise methods for assessing renal function and guiding therapeutic intervention. Bedside Schwartz formula with the cystatin-C-based Full Age Spectrum formula and Chronic Kidney Disease in Children (CKiD) U 25 formula used in estimating glomerular filtration rate (eGFR) and also to assess if the eGFR in association with kidney length percentiles can be a monitoring parameter for the progression of chronic kidney disease in children with congenital anomalies of the kidney and urinary tract (CAKUT). A total of 64 pediatric patients (median age at diagnostic was 12 months with an interquartile range of 2 to 60) were diagnosed with congenital anomalies in the kidney and urinary tract between June 2018 and May 2023 at “Louis Turcanu” Emergency Hospital for Children in Timisoara, Romania. Baseline characteristics, CAKUT types, associated pathologies, CKD staging, and eGFR using creatinine and cystatin C were analyzed. The mean age at the moment of examination was 116.50 months; (65, 180). Chronic kidney disease staging revealed a predominance of patients in CKD stages G1 and A1. Analysis of eGFR methods revealed a small mean difference between eGFR estimated by creatinine and cystatin C, with a moderate-strong positive correlation observed between the eGFR and ultrasound parameters. Using cystatin-C-based formulas for eGFR, in conjunction with ultrasound measurements, may offer reliable insights into renal function in pediatric patients with congenital anomalies affecting the kidney and urinary tract. However, the economic aspect must be taken into consideration because cystatin C determination is approximately eight times more expensive than that of creatinine. An interdisciplinary approach is crucial for managing patients with CAKUT. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Prognosis, and Management of Urinary Disease)
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14 pages, 1322 KiB  
Systematic Review
Outcomes of Salvage Treatment After Primary Treatment for Renal Cell Cancer: A Systematic Review
by Nicola Longo, Francesco Di Bello, Luigi Napolitano, Ernesto Di Mauro, Simone Morra, Giuliano Granata, Federico Polverino, Agostino Fraia, Gabriele Pezone, Roberto La Rocca, Claudia Collà Ruvolo, Gianluigi Califano and Massimiliano Creta
Diagnostics 2025, 15(7), 838; https://doi.org/10.3390/diagnostics15070838 - 25 Mar 2025
Viewed by 328
Abstract
Background/Objective: The grade of recommendation for renal cell carcinoma (RCC) salvage treatment options is weak. The aim of the current study is to summarize available evidence about the surgical, oncological, and functional outcomes of salvage renal options after previous treatments for RCC. [...] Read more.
Background/Objective: The grade of recommendation for renal cell carcinoma (RCC) salvage treatment options is weak. The aim of the current study is to summarize available evidence about the surgical, oncological, and functional outcomes of salvage renal options after previous treatments for RCC. Methods: A systematic search (PROSPERO: CRD42024618629) was performed according to the PRISMA statement. A pooled analysis was performed to quantify the effect size (ES) for an overall postoperative Clavien–Dindo (CD) grade ≥ III and postoperative and intraoperative complications for either partial or radical nephrectomy (PN or RN) subgroups. Results: Overall, 11 studies involving 331 patients were included in the final analysis. The median age ranged from 44 to 75 years. Primary treatments for RCC included 267 (80.6%) PNs, 40 (12.0%) radiofrequency ablations (RFAs), 23 (6.9%) cryotherapies, and 1 (0.3%) stereotactic radiotherapy. Overall, the median time of local recurrence for RCC patients was from 25 to 99 months for PNs, 13 months for RFA and cryotherapy, and 6 months for stereotactic radiotherapy. The overall pooled analysis was associated with an ES of 0.28 for overall postoperative complications and of 0.11 for CD ≥ III postoperative complications (all p < 0.001). Within subgroup analyses, RN was invariably associated with less complications (the ES ranged from 0.05 to 0.17). Conclusions: The profile of oncological safety as well as the morbidity and mortality of salvage treatment options for RCC may justify considering such procedures in a salvage setting. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Prognosis, and Management of Urinary Disease)
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