Uro

The prevalence of kidney stone (KS) disease and cardiometabolic diseases are simultaneously increasing in the United States. Dyslipidemia has been associated with an increased risk for KS formation and recurrence due to alterations in metabolism of purine and oxalate along with a defective urinary acidification mediated through insulin resistance. In addition, direct renal lipotoxicity, oxidative stress and crystal-induced inflammation also play a role. Although there are systematic reviews, metabolic analyses, cohort studies, and National Health and Nutrition Examination Survey (NHANES)-based studies on association of specific lipid phenotypes with urinary KS profiles, there is still insufficient evidence to include lipid profiles in metabolic evaluation for recurrent stone disease. Observational data suggest that lipid-lowering therapies may reduce stone risk. In this review, we provide a comprehensive overview of the epidemiological evidence linking dyslipidemia to KS disease, the underlying pathophysiology connecting dyslipidemia and stone formation along with the clinical implications for the metabolic evaluation, and the emerging data on pharmacologic therapies that may offer stone-protective benefits.

Background: Deep learning systems for Gleason grading are developed almost entirely on high-end clinical scanners and on cohorts from a small number of Western institutions, yet deployment increasingly involves other devices and other populations. These two distribution shifts, device and population, are rarely tested together on the same physical slides. The PAR dataset, from Erbil, Iraq, digitizes each biopsy on three scanners and provides three distinct pathologist grades, so it permits both tests at once on a Middle Eastern cohort. A concurrent study by the dataset originators validated a task-specific model and two foundation models on PAR; we complement it by testing an independently developed detect-then-grade pipeline and by separating scanner effects on detection from scanner effects on grading. Methods: We applied one fixed model developed on North American and European material to all 1017 whole-slide images (339 slides from 185 patients, three scanners; 49.6% clinically significant cancer) with no scanner-specific or population-specific tuning. We measured cancer detection (area under the ROC curve of the predicted cancer tissue fraction), all-slide ISUP agreement of the deployed detect-then-grade pipeline (quadratic-weighted kappa, QWK), and grading agreement on pathologist-confirmed cancers, at the slide level and, because a case carries up to two slides, at the patient level. The reference reader was S.A.; thresholds and operating points were cross-validated leave-one-out; scanners were compared by paired within-biopsy bootstrap and confidence intervals confirmed by patient-cluster bootstrap. Results: Detection was statistically equivalent across scanners (AUC 0.987 to 0.991; paired differences at most 0.003) and transferred to this non-Western cohort with no per-population tuning. At a 95% sensitivity operating point, the deployed pipeline reached cross-validated all-slide QWK of 0.86, 0.81, and 0.86 (Grundium, Hamamatsu, Leica), matching the inter-pathologist ceiling of 0.81, against 0.23 to 0.62 for the ungated model. Grading of confirmed cancers was scanner-dependent: the compact Grundium (0.63) did not differ from the clinical Leica (0.67; paired difference 0.04, 95% CI −0.03 to 0.11), while both exceeded Hamamatsu (0.44). Results held at the patient level, with grading somewhat lower for two scanners; the two slides of a case disagreed in grade in 43% of cases, and patient clustering did not widen the intervals. Conclusions: Cancer tissue fraction is a triage signal robust across scanner and transferable to an underrepresented population for detection, while grading is the scanner-sensitive step. Prostate grading models should be deployed as a detect-then-grade pipeline, with grading validated per device and confirmed on the local population.

Background: Apical pelvic organ prolapse remains a considerable surgical challenge given its comparatively high recurrence rates. The EnPlace^® device provides a mesh-free, minimally invasive option for sacrospinous ligament fixation (SSLF). This study evaluates the long-term safety and durability of SSLF performed with the EnPlace^® device. Methods: We conducted a retrospective cohort study at Assuta Medical Center between October 2020 and October 2021, enrolling 91 patients with stage III–IV apical POP who underwent SSLF with the EnPlace^® device. Data were extracted from a real-time institutional database. Patients were assessed at 1 day, 1 month, and 6 months postoperatively, and patient-reported satisfaction was subsequently obtained by telephone interview at 3–4 years. Results: The cohort comprised 91 women (mean age 63.9 ± 11.85 years); prolapse was uterine in 80 (87.9%) and involved the vaginal vault in 11 (12.1%), with mean preoperative point C measurements of 2.11 ± 3.04 and 1.55 ± 3.01, respectively. Concomitant colporrhaphy was performed in all patients, and 19 (20.9%) also underwent a mid-urethral sling. Surgery lasted a mean of 23.46 ± 5.09 min, with mean blood loss of 23.7 ± 6.06 mL, and no intraoperative or early postoperative complications were recorded. By 6 months, POP-Q values had improved to a mean point C of −4.84 ± 1.05 cm, point Ba of −2.25 ± 0.69 cm, and point Bp of −2.63 ± 0.69 cm. Surgical failure occurred in two patients (2.5%) with uterine prolapse, both of whom were successfully managed with repeat SSLF using EnPlace^®, and recurrent stage II cystocele was identified in five patients (5.2%), all treated with a pessary. At 3–4 years, patient-reported satisfaction was available for 75 of 91 patients (82.4%) and averaged 91.93% ± 17.06; no repeat objective (POP-Q) assessment was performed at this later time point. Conclusions: These findings indicate that the EnPlace^® device offers a favorable safety and efficacy profile for apical POP repair, characterized by low recurrence and high patient satisfaction, representing a promising alternative to conventional techniques. Given its minimally invasive nature and compatibility with regional anesthesia, this approach may be of particular interest for older or higher-risk surgical candidates; further prospective research incorporating formal frailty and surgical-risk assessment is warranted to confirm this potential benefit.