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Diagnostics
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Clinical Diagnosis and Management in Urology
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Clinical Diagnosis and Management in Urology

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

Deadline for manuscript submissions: closed (31 December 2025) | Viewed by 7699

Special Issue Editor

Dr. Roberto Falabella

E-Mail Website
Guest Editor
Urology Unit, AO San Carlo, Potenza, Italy
Interests: uro-oncology; robotic surgery; andrology

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to an upcoming Special Issue titled “Clinical Diagnosis and Management in Urology”.

In recent years, we have seen rapid progress in the field of urology.

Improvements in diagnostics and surgical methods have led to better and tailored treatments for patients. Improved Psma Pet-Tc for prostate cancer and new biomarkers for screening and early diagnosis in bladder cancer have all contributed to better planning and helped to improve surgical techniques and outcomes. In addition, advancements in urology, such as minimally invasive surgery, have greatly improved outcomes, paving the way for early intervention and less invasive treatments.

This Special Issue will enhance our knowledge regarding the latest advancements in clinical diagnosis and management in urology. Original research articles, reviews, and other paper types are welcome. Research areas may include new surgically techniques, innovative diagnostical tools, and clinical management strategies. We look forward to receiving your valuable submissions.

Dr. Roberto Falabella
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

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

  • minimally invasive surgery
  • early diagnosis
  • cancer biomarkers
  • diagnostic technology
  • surgical challenges
  • early diagnosis in urological cancers

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

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Research

Jump to: Review

20 pages, 1483 KB  
Article
Beyond Binary Cutoffs: An Explainable Machine Learning Framework for Individualized Diagnostic Reasoning in Suspected Urolithiasis
by Kyungman Cha, Sang Hoon Oh, Jaekwang Shin and Jee Yong Lim
Diagnostics 2026, 16(9), 1313; https://doi.org/10.3390/diagnostics16091313 - 27 Apr 2026
Viewed by 277
Abstract
Background: Emergency department evaluation of suspected urolithiasis increasingly relies on non-contrast CT, yet not all patients require imaging. Existing clinical prediction rules help stratify stone probability, but by converting continuous measurements into fixed binary indicators, they offer little insight into why a [...] Read more.
Background: Emergency department evaluation of suspected urolithiasis increasingly relies on non-contrast CT, yet not all patients require imaging. Existing clinical prediction rules help stratify stone probability, but by converting continuous measurements into fixed binary indicators, they offer little insight into why a particular patient is at risk or how much uncertainty remains after each testing stage—questions that bear directly on individualized diagnostic decisions. Methods: We retrospectively analyzed 1000 ED patients with suspected urolithiasis who underwent non-contrast CT (stone prevalence 85.0%). A gradient boosting classifier was trained on 17 continuous clinical and laboratory features and compared against binary-thresholded counterparts and an established scoring system; the 17-feature model achieved AUC 0.771 (95% CI 0.726–0.813) versus 0.723 (95% CI 0.675–0.771) for the reference score on this cohort (DeLong p = 0.001). Individual predictions were explained using an interventional Shapley value approach, and a Shannon entropy-based framework was applied to quantify the marginal diagnostic contribution of each sequential testing stage. Results: Held-out permutation importance identified red blood cell count on microscopy, age, pain duration, and prior stone history as the most influential predictors. Several features showed non-linear contributions that diverged from conventional binary thresholds: creatinine effect crossed zero near 0.90 mg/dL and pain duration peaked between 2 and 5 h. C-reactive protein, absent from existing scoring systems, emerged as a meaningful negative predictor. Sequential entropy analysis showed that dipstick urinalysis provided the largest marginal information gain among non-history stages (6.1% of prior entropy), while physical examination contributed 2.3%. A prevalence sensitivity analysis projected that the framework’s threshold behavior would differ substantially in lower-prevalence populations, underscoring that the cohort-specific cut-points are not portable decision rules. We therefore position the framework as a reasoning aid that complements clinical judgment and imaging, not as a stand-alone triage tool. Conclusions: Explainable machine learning can address questions that aggregate discrimination metrics cannot: which features drive risk for a given patient, how those effects behave across the continuous measurement range, and how much diagnostic uncertainty each testing stage resolves. The Shapley-based explanations and entropy framework developed here offer a structured approach to individualized diagnostic reasoning in the ED evaluation of suspected urolithiasis, functioning as an interpretive adjunct to, rather than a replacement for, existing clinical tools and CT imaging. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management in Urology)
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12 pages, 856 KB  
Article
Impact of 3D Virtual Modeling on Perioperative Outcomes in Robot-Assisted Partial Nephrectomy
by Francesco Passaro, Achille Aveta, Gianluca Spena, Antonio Tufano, Savio Domenico Pandolfo, Giovanni Grimaldi, Dario Franzese, Luigi Castaldo, Giuseppe Quarto, Eleonora Monteleone, Laura Brunella Alfè, Giovanna Canfora, Sonia Desicato, Antonio Scarpato, Raffaele Muscariello, Alessandro Izzo, Roberto Contieri and Sisto Perdonà
Diagnostics 2026, 16(7), 1082; https://doi.org/10.3390/diagnostics16071082 - 3 Apr 2026
Viewed by 545
Abstract
Background/Objectives: Robot-assisted partial nephrectomy (RAPN) remains a technically demanding procedure, associated with a non-negligible risk of perioperative complications. This study aimed to assess the impact of preoperative planning and intraoperative navigation using patient-specific three-dimensional (3D) virtual model reconstructions on perioperative outcomes of RAPN. [...] Read more.
Background/Objectives: Robot-assisted partial nephrectomy (RAPN) remains a technically demanding procedure, associated with a non-negligible risk of perioperative complications. This study aimed to assess the impact of preoperative planning and intraoperative navigation using patient-specific three-dimensional (3D) virtual model reconstructions on perioperative outcomes of RAPN. Methods: We analyzed 307 patients who underwent RAPN for renal tumors at a tertiary center between 2021 and 2024. Starting in 2023, 3D modeling (Medics3D) was integrated for selected cases (n = 69) and compared to a 2D-imaging control group (n = 238). The primary outcome was trifecta achievement, defined as the simultaneous presence of negative surgical margins, ≥90% preservation of preoperative eGFR at discharge, and absence of perioperative complications. Clamping strategies were categorized as on-clamp, selective/super-selective, or off-clamp. Mann–Whitney and Chi-squared tests compared the groups; multivariable logistic regression identified independent predictors of trifecta achievement. Results: Baseline characteristics were balanced between the 3D and control groups: median age (62 vs. 61 years, p = 0.5), BMI (28 vs. 26, p = 0.3), and eGFR (85 vs. 86 mL/min/1.73 m2, p = 0.5). Median tumor size was 4.2 vs. 4.0 cm (p = 0.4), and RENAL complexity was comparable (p = 0.12). Selective or super-selective clamping was significantly more frequent in the 3D group (32% vs. 15%; p < 0.01). While WIT (17.5 vs. 18.5 min, p = 0.09) and complication rates (26% vs. 29%, p = 0.7) were similar, the 3D group showed a significantly lower rate of positive surgical margins (5% vs. 15%; p = 0.030). Trifecta achievement was significantly higher in the 3D group (51% vs. 32%; p = 0.004). On multivariable analysis, 3D modeling remained an independent predictor of trifecta achievement (OR 2.1, 95% CI 1.17–3.70; p = 0.013). Conclusions: The use of patient-specific 3D kidney reconstructions was associated with improved perioperative outcomes in patients undergoing RAPN. These findings support the integration of 3D modeling into routine surgical workflows to enhance operative precision and optimize patient outcomes. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management in Urology)
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16 pages, 5879 KB  
Article
Evaluation of Serum and Urine GDF-15 Levels in Patients with Ureteral Stones
by Gorkem Akca, Ertugrul Yigit, Merve Huner Yigit, Erdem Orman, Eyup Dil and Hakki Uzun
Diagnostics 2026, 16(1), 130; https://doi.org/10.3390/diagnostics16010130 - 1 Jan 2026
Viewed by 717
Abstract
Background: Acute renal colic, most often caused by ureteral stones, is a common cause of emergency admissions. While non-contrast computed tomography (CT) is the diagnostic gold standard, its use is limited by radiation exposure, cost, and accessibility. Growth Differentiation Factor-15 (GDF-15) is [...] Read more.
Background: Acute renal colic, most often caused by ureteral stones, is a common cause of emergency admissions. While non-contrast computed tomography (CT) is the diagnostic gold standard, its use is limited by radiation exposure, cost, and accessibility. Growth Differentiation Factor-15 (GDF-15) is a stress-induced cytokine elevated in various acute pathologies. This study investigated the diagnostic and predictive value of serum and urine GDF-15 in patients with acute renal colic due to ureteral stones. Methods: In this prospective observational study (January 2024–March 2025), 76 patients presenting with sudden-onset flank pain were enrolled. A total of 41 patients with radiologically confirmed ureteral stones formed the stone-positive group, and 35 patients without urinary pathology served as controls. Serum and urine GDF-15 levels were measured by ELISA, along with routine laboratory tests. CT was used to assess stone characteristics, hydronephrosis grade, and ureteral wall thickness. Group comparisons were performed using the Mann–Whitney U test, correlations with Spearman’s test, and diagnostic performance with ROC analysis. Results: Both serum and urine GDF-15 levels were significantly higher in stone-positive patients (p < 0.001). Urine GDF-15 demonstrated excellent diagnostic accuracy (AUC = 0.986; sensitivity = 92.7%; specificity = 91.4), while serum GDF-15 showed moderate performance (AUC = 0.767). GDF-15 levels showed modest positive correlations with CRP and were numerically higher in patients with ureteral wall thickness > 1 mm and proximal stones. No significant association was found with spontaneous stone passage (p > 0.05). Conclusions: Urine GDF-15 shows promising diagnostic accuracy for ureteral stones and may serve as a non-invasive adjunctive tool when imaging is limited. While associated with inflammation and stone location, it did not predict spontaneous stone passage. These findings support its potential as a clinical biomarker, though further large-scale validation is required. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management in Urology)
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15 pages, 922 KB  
Article
Outcomes of Transobturator Tape Surgery for Stress and Mixed Urinary Incontinence: A 12-Year Retrospective Review
by Cheng-Feng Lin, Hung-Yi Chen, Chun-Te Wu, Kuan-Lin Liu, Cheng-Chia Lin, Heng-Jung Hsu, Chin-Chan Lee and Chun-Yu Chen
Diagnostics 2025, 15(20), 2611; https://doi.org/10.3390/diagnostics15202611 - 16 Oct 2025
Viewed by 1327
Abstract
Background: Stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) are common disorders that impair quality of life. While transobturator tension-free vaginal tape (TVT-O) is established for SUI, outcomes in MUI remain uncertain. Methods: We analyzed 111 women who underwent TVT-O [...] Read more.
Background: Stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) are common disorders that impair quality of life. While transobturator tension-free vaginal tape (TVT-O) is established for SUI, outcomes in MUI remain uncertain. Methods: We analyzed 111 women who underwent TVT-O at Keelung Chang Gung Memorial Hospital. Baseline data included demographics, Overactive Bladder Symptom Score (OABSS), uroflowmetry [peak flow rate (PFR), residual urine (RU)], and Pelvic Organ Prolapse Quantification (POP-Q) stage. The primary outcome was OABSS improvement (≥1-point reduction); secondary outcomes were longitudinal OABSS, uroflowmetry, pad usage, and POP-Q stage. Results: At 3 months, 31.5% (35/111) met responder criteria. Symptom improvement occurred more often in MUI than in SUI, with about half of women with MUI (48.6%) and one quarter of those with SUI (27.4%) reporting subjective improvement (p = 0.018). OABSS improved in MUI (7.92 → 7.18, p = 0.001) but worsened in SUI (6.84 → 7.52, p < 0.001). In SUI, PFR increased (p = 0.001) and RU decreased (p = 0.029); no significant changes occurred in MUI. MUI independently predicted response (OR, 2.59; 95% CI, 1.10–6.14) and greater ΔOABSS (β = −1.391, p < 0.001); higher baseline OABSS also predicted improvement (β = −0.093, p = 0.049). For pad usage, MUI was associated with persistence (OR, 3.855, p = 0.010). ROC analysis showed modest discrimination for MUI (AUC 0.626, p = 0.034). Conclusions: TVT-O provided symptom relief, with about half of the women with MUI, and one quarter of those with SUI experienced subjective improvement. Women with MUI and higher baseline OABSS were more likely to improve, but these findings should be interpreted with caution, given the modest sample size. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management in Urology)
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Review

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19 pages, 1419 KB  
Review
Beyond One-Size-Fits-All Active Surveillance for Low-Risk Prostate Cancer: Risk-Adapted Follow-Up, De-Escalation Pathways, and Focal Therapy as Tailored Strategy
by Fabio Zattoni, Andrea Mari, Ugo Giovanni Falagario, Riccardo Giuseppe Bertolo, Simone Albisinni, Daniele Amparore, Lorenzo Bianchi, Riccardo Campi, Roberto Contieri, Elisa De Lorenzis, Paolo Dell’Oglio, Michele Marchioni, Veronica Mollica, Marco Moschini, Francesco Soria, Michele Talso, Filippo Turri and Savio Domenico Pandolfo
Diagnostics 2026, 16(9), 1310; https://doi.org/10.3390/diagnostics16091310 - 27 Apr 2026
Viewed by 383
Abstract
Low-risk prostate cancer (PCa) has historically been overtreated, exposing men to unnecessary morbidity. Emerging evidence supports conservative management of low-risk PCa without immediate radical intervention. Contemporary data show a marked decline in surgical overtreatment, with the proportion of radical prostatectomies yielding only Grade [...] Read more.
Low-risk prostate cancer (PCa) has historically been overtreated, exposing men to unnecessary morbidity. Emerging evidence supports conservative management of low-risk PCa without immediate radical intervention. Contemporary data show a marked decline in surgical overtreatment, with the proportion of radical prostatectomies yielding only Grade Group 1 cancers falling from 32.4% in 2010 to 7.8% in 2020 in the US SEER registry. Long-term studies confirm that deferring treatment is safe for low-risk disease, with PCa-specific survival exceeding 95% at 15–25 years for cohorts managed with surveillance. Major guidelines now endorse active surveillance (AS) as the preferred management for low-risk PCa. An alternative risk stratification system that expands the low-risk category was shown to reclassify 45–83% more men as low risk without increasing 15-year PCa mortality. Focal therapy has emerged as a potential middle-ground strategy, though evidence is still limited. The paradigm for managing low-risk PCa has shifted toward conservatism, with AS firmly established as the standard of care. Continued efforts to refine risk stratification and evaluate focal therapy are needed to further optimize individualized care, minimize harm, and maintain excellent cancer-specific outcomes for low-risk PCa. This comprehensive review aims to create a practical, risk-adapted framework for managing patients on AS. We will: (i) summarize inclusion criteria and outcomes, (i) compare AS follow-up schedules across major institutions and guidelines, (iii) provide evidence-based criteria to de-intensify surveillance in men with sustained stability and (iv) clarify the role of focal therapy as an intermediate treatment option within the AS continuum. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management in Urology)
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35 pages, 961 KB  
Review
Predictive Factors for Gastrointestinal and Genitourinary Toxicities in Prostate Cancer External Beam Radiotherapy: A Scoping Review
by Jerry C. F. Ching, Kelvin C. K. Liu, Isaac K. H. Pang, Alexander J. Nicol, Vincent W. S. Leung, Jing Cai and Shara W. Y. Lee
Diagnostics 2025, 15(11), 1331; https://doi.org/10.3390/diagnostics15111331 - 26 May 2025
Cited by 6 | Viewed by 3787
Abstract
Advancements in radiotherapy (RT) techniques such as intensity modulation, image guidance, and hypofractionation have facilitated a satisfactory survival outcome in prostate cancer (PCa) patients. However, virtually all PCa patients suffer from various types and extents of radiation toxicities, which are mainly gastrointestinal (GI) [...] Read more.
Advancements in radiotherapy (RT) techniques such as intensity modulation, image guidance, and hypofractionation have facilitated a satisfactory survival outcome in prostate cancer (PCa) patients. However, virtually all PCa patients suffer from various types and extents of radiation toxicities, which are mainly gastrointestinal (GI) and genitourinary (GU) in nature, eroding their quality of life. Thus, early mitigation and preventative measures should be offered, enabled by accurate toxicity prediction. This scoping review provides a comprehensive summary of reported acute and late GI and GU toxicity predictors of conventional fractionation (CFRT), moderate hypofractionation (MHRT), and ultra-hypofractionation (UHRT). A total of 169 studies published between the years 2000 and 2024 (inclusive) were identified from four databases, with 127 and 78 studies investigating GI and GU toxicities, respectively. Univariate analysis was employed in 139 studies to identify predictors, while 94 studies involved multivariate analysis, 40 involved internal model validation, and 5 performed external model validation. Among all studies, dosimetric predictors are the most reported factors, followed by patient, clinical, treatment, disease, genetic, and radiomic features. However, their applicability and performance have not yet been extensively proven in external validation involving multicenter studies. Future predictive studies should also focus on deeper multimodality information, such as radiomics, in addition to the categories of factors consolidated in this study, for an all-rounded investigation. A multicenter study is highly encouraged for prospective external validation. Further investigations into delivered doses and sub-volumes of various regions of interest are necessary. Comprehensive reporting items suggested in this work shall facilitate the reproducibility and comparability of the results. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management in Urology)
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