Search Results (85)

Background: Upper tract urothelial carcinoma (UTUC) is a rare malignancy with prognosis predicated on clinical and pathological factors. Radical nephroureterectomy is the standard treatment for higher risk localized UTUC, although competing mortality may influence optimal treatment selection in older patients. Methods: A retrospective population-based cohort study was conducted using the Surveillance, Epidemiology, and End Results program. Individuals diagnosed with UTUC of the renal pelvis or ureter between 2000 and 2017 were included. Patients with unknown tumor grade or size were excluded. Results: A total of 10,894 patients were included. During a median follow-up of 26 months, 57% died from any cause and 27% died from UTUC. For each 5-year increase in age of diagnosis, the cancer-specific mortality risk rises more in low-grade patients (21% increased riskjtp: 0.008) than high-grade patients (9% increased risk p: 0.023). Other-cause mortality risk rose markedly with increasing age (SHR 3.54 for ages 85+, p < 0.001). Conclusions: Age at diagnosis is significantly associated with cancer-specific mortality in UTUC. Incorporating age and competing risk into risk stratification may help inform shared decision-making regarding treatment approaches in older patients. Full article

Objective: This study aimed to evaluate the effectiveness of robot-assisted laparoscopic pyeloplasty (RALP) in pediatric hydronephrosis with or without abdominal pain symptoms, and to compare post-operative outcomes between these two clinical subtypes. Methods: We retrospectively reviewed pediatric patients who underwent RALP at our institution between April 2020 and October 2024. Patients were categorized into hydronephrosis with and without abdominal pain groups. The primary endpoints were renal pelvis anteroposterior diameter (APD) and percent improvement in APD (PI-APD). Inverse probability of treatment weighting (IPTW) was applied to minimize selection bias and balance baseline covariates. Results: A total of 273 pediatric patients were analyzed, including 104 cases with abdominal pain and 169 without. After IPTW adjustment, the baseline characteristics of the groups were comparable. At 6 months post-operative, the abdominal pain group showed slower reduction in APD (1.3 cm vs. 1.2 cm, p < 0.05) and PI-APD (37% vs. 50%, p < 0.05). No significant differences were observed at the 12-month or last follow-up. The overall surgical success rate was 97.1% (265/273). The IPTW-adjusted analysis revealed a higher surgical success rate in the abdominal pain group (99.9% vs. 97.1%, p < 0.05). Conclusions: RALP is safe and effective for pediatric hydronephrosis, regardless of the presence of abdominal pain. Although both groups showed comparable recovery at 12 months or last follow-up, the patients with abdominal pain exhibited slower improvement at 6 months, suggesting potential differences in early post-operative remodeling between these subtypes. Full article

Background and Objectives: The systemic inflammatory response is important in cancer prognosis and progression. The inflammatory burden index (IBI) provides information about both inflammation and the immune response. Urothelial carcinomas are immunogenic; therefore, it has been suggested that inflammatory indices may predict disease prognosis. The aim of this study was to investigate the effects of systemic inflammatory indices, particularly the inflammatory burden index, on disease progression and overall survival in patients with metastatic urothelial cancer (affecting the bladder and upper urinary system) before first-line treatment and to demonstrate their prognostic importance. Materials and Methods: Within the scope of the study, the medical records of 130 patients who received systemic treatment for metastatic urothelial carcinoma at the medical oncology clinic were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal threshold values for IBI. Survival rates were calculated using the Kaplan–Meier method, and survival differences between groups were compared with the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model to evaluate prognostic factors. Results: A total of 130 patients were included in the study. The median age was 64.9 years (IQR: 57.2–70.5). The primary tumor location was the bladder in 84.6% of patients, while the remaining 15.4% originated from the ureter and renal pelvis. In first-line systemic treatment, patients received a median of 4 cycles (IQR: 3–6). The median number of total treatment lines administered for metastatic disease was 1 (IQR: 1–2). In progression-free survival (PFS) analyses, the median PFS was 9.20 (95% CI 6.55–11.85) months in the IBI-low group (n = 47) and 5.82 (95% CI 4.56–7.07) months in the IBI-high group (n = 83) (p < 0.001). The median OS was calculated to be 18.96 (95% CI 16.61–21.30) months in the IBI-low group (n = 47), while it was found to be 9.50 (95% CI 7.70–11.29) months in the IBI-high group (n = 83) (p < 0.001). In multivariate analysis, high IBI and the presence of brain metastasis were found to be associated with the risk of progression. In terms of overall survival, the presence of brain metastasis, the presence of visceral metastasis, ECOG PS status, receipt of maintenance therapy, LMR, and the IBI score showed statistically significant prognostic effects. Conclusions: In metastatic urothelial carcinoma, the IBI was identified as an independent prognostic factor associated with progression-free and overall survival. These findings suggest that the IBI may have potential utility as a prognostic biomarker; however, larger, multicenter, and prospective studies are required to further validate its clinical applicability. Full article

Background: Retroperitoneal surgical corridors, particularly in robotic-assisted partial nephrectomy and donor surgery, require precise knowledge of hilar vascular orientation. The typically described Vein–Artery–Pelvis (VAP) anatomy is often assumed, yet its reliability is poorly quantified. Therefore, the purpose of the present study is to provide a comprehensive radioanatomical map of hilar architecture to enhance surgical safety and predictability. Methods: Contrast-enhanced computed tomography (CT) scans of the abdomen from 200 patients (104 males and 96 females) were evaluated. The anterior-to-posterior sequence of hilar structures, the frequency of early vascular branching, and the presence of accessory vessels were documented and stratified by sex and laterality. Results: The conventional VAP sequence was observed in a minority of cases, occurring in only 32.6% (131 sides). The map identified 37 distinct sequence variants. The most common variants included VAPA (9.0%), AVAP (7.8%), and VAAP (7.0%). Adherence to typical VAP anatomy was significantly lower in males (27.9%) than in females (37.7%). Arterial complexity, characterized by early branching or accessory vessels, was present in 43.2% of sides, with a significantly higher occurrence in males and on the right side. Venous mapping revealed a marked lateral disparity; accessory veins were predominantly right-sided (12.5%), whereas early venous branching was predominantly a left-sided feature (30.0%). Conclusions: Renal hilar architecture demonstrates substantial variability, with the classical VAP configuration representing a minority arrangement. These findings highlight the importance of individualized preoperative imaging assessment and may help anticipate anatomical complexity in retroperitoneal surgery. Full article

Background/Objectives: Midurethral sling (MUS) surgery is a standard treatment for stress urinary incontinence in women. Obturator-route MUS procedures reduce retropubic morbidity, but rare concealed hemorrhagic complications can be severe and rapidly progressive. This report describes a complex case of life-threatening hemorrhage, upper urinary tract extravasation, and delayed infection involving a persistent pelvic collection after obturator-route MUS. Methods: We reviewed the clinical course, imaging findings, interventions, and follow-up of a 77-year-old woman who developed severe complications after outpatient obturator-route MUS. A descriptive narrative summary of published hemorrhagic complications after TOT or TVT-O procedures was also performed. Result: On postoperative day 1, the patient presented with left lower abdominal pain, dizziness, vomiting, tachycardia, and severe anemia. Contrast-enhanced computed tomography showed active bleeding from the left obturator artery, an 11.5 cm pelvic hematoma with bladder displacement, and upper urinary tract contrast extravasation at the left renal pelvis and ureteropelvic junction. Emergency transcatheter arterial embolization and left percutaneous nephrostomy were performed, followed by delayed antegrade double-J ureteral stenting. Four months later, she developed E. coli urosepsis with a persistent 7.9 cm paravesical collection. Persistent symptoms despite initial antibiotic therapy required broad-spectrum antibiotics and percutaneous catheter drainage. The drainage fluid was serous, and S. hominis isolated from the drainage culture was interpreted as a contaminant; therefore, the collection was managed as a clinically suspected infection involving a persistent pelvic collection rather than as a microbiologically confirmed infected hematoma. Conclusions: After obturator-route MUS, severe abdominal or pelvic pain, dizziness, tachycardia, hypotension, or abrupt hemoglobin decline should prompt contrast-enhanced CT to evaluate for concealed pelvic arterial bleeding and associated urinary tract extravasation. Early multidisciplinary coordination and follow-up of persistent pelvic collections may be important in complex cases. Full article

Therapeutic interventions within the urinary system are often limited by the complex and tortuous anatomy of the renal pelvis and ureters, restricting access to deep regions and increasing the risk of mucosal trauma. In this study, we present a multifunctional, magnetically controlled ferrofluid droplet robotic platform engineered for high deformability and precision navigation. A custom electromagnetic actuation system was developed and optimized via COMSOL Multiphysics (version 6.3, COMSOL Inc., Stockholm, Sweden) simulations to generate programmable magnetic fields. Experimental validation in both simplified environments and anatomically realistic 3D-printed urinary tract models demonstrated the droplets’ capacity for controlled locomotion, reversible deformation, and traversing constrictions significantly smaller than their resting diameter. The droplets’ locomotion and extreme deformability are governed by the dynamic balance between the applied magnetic gradient forces, the restoring interfacial tension of the ferrofluid, and the fluidic viscous drag. Quantitatively, the droplets achieved robust translational velocities up to 260 mm/s under single-coil actuation (51 mT, 20 Hz) and 108 mm/s under a more stable dual-coil configuration (51 mT, 8.3 Hz). Furthermore, two clinically relevant functionalities were successfully executed: rapid vibration-induced release of encapsulated dye for targeted drug delivery, and the precise mechanical capture and transport of artificial kidney stones. These results establish a highly versatile platform for minimally invasive urological procedures, highlighting the immense potential of soft magnetic microrobotics for integrated therapeutic applications. Full article

Primary squamous cell carcinoma (SCC) of the prostate is a rare and biologically aggressive malignancy lacking a standardized management strategy. De novo primary SCC arising without prior androgen deprivation therapy or radiotherapy is uncommon and presents significant diagnostic and therapeutic challenges. We present the clinical presentation, diagnostic evaluation, treatment strategy, and early therapeutic response of de novo primary SCC of the prostate in a 56-year-old male with end-stage renal disease on maintenance hemodialysis. The patient presented with gross hematuria and a bulky prostate mass invading the bladder with bilateral pelvic lymphadenopathy despite low prostate-specific antigen (PSA) levels. Histopathological and immunohistochemical analyses confirmed pure SCC, staged as cT4N1M0. Because systemic chemotherapy was contraindicated and surgery was not feasible, definitive whole-pelvis radiotherapy with a simultaneous integrated boost was administered. Marked tumor regression was observed one month after treatment. Subsequent imaging demonstrated extensive tumor necrosis with fistulous communication in the context of locally invasive disease. Because long-term oncologic durability could not be assessed owing to non-oncologic clinical deterioration, these findings suggest that definitive radiotherapy may provide meaningful locoregional tumor control in selected medically inoperable patients with de novo prostatic SCC. Full article

Uriniferous perinephric pseudocysts (PNPs) are a rare condition in cats, primarily managed by nephrectomy to eliminate persistent urinary leakage. Organ preservation is critical in cases with solitary kidneys. This report describes a cat with congenital absence of the right kidney that developed a uriniferous PNP secondary to abnormal communication between the calyceal diverticulum and subcapsular space. A 6-year-and-11-month-old neutered male Ragdoll cat presented with abdominal distension and lethargy. Ultrasonography revealed an extensive subcapsular perinephric fluid and a cystic lesion adjacent to the renal pelvis. Contrast-enhanced computed tomography with excretory urography directly demonstrated the time-dependent passage of contrast medium from the renal pelvis into the calyceal diverticulum and subsequent leakage into the subcapsular space, allowing precise identification of the renal leakage pathway. Based on these findings, an operation was performed using a non-vascularized free omental plug inserted into the diverticular opening and secured using capsular sutures. Postoperative drainage resolved rapidly, renal function normalized, and no recurrence was detected during long-term follow-up of up to 465 days. To the best of our knowledge, this is the first report to describe an organ-sparing surgical approach that directly addresses the renal leakage pathway in feline uriniferous PNPs. Full article

This study aimed to assess phytochemical profiles and antioxidant activities of lyophilized black currant fruit juice (BCLJ) and its corresponding waste extract (BCLW) from the Čačanska crna variety, and to evaluate their antiproliferative properties. The main anthocyanins quantified through HPLC-DAD analysis were delphinidin-3-O-rutinoside and cyanidin-3-O-rutinoside, with significantly higher levels in BCLW. Antioxidant activity was examined using the DPPH and β-carotene/linoleic acid methods, with BCLW showing superior effects in both. Antiproliferative potential was evaluated by determining the Ki67 index in renal epithelial cells of rats treated with BCLJ or BCLW. Thirty healthy male rats were randomly assigned to five groups (n = 6) and administered BCLJ or BCLW orally for ten days, receiving 100, 200, and 300 mg/kg b.w. of BCLW (BCLW1, BCLW2, and BCLW3 groups, respectively) or 200 mg of BCLJ. Histopathological and immunohistochemical parameters were assessed in rats’ kidneys. Across all epithelial types (cortical proximal tubules, distal medullary proximal tubules, collecting ducts, and urothelial cells of the renal pelvis), the highest Ki67 indices were observed in control animals, particularly in collecting ducts and cortical proximal tubules. The lowest Ki67 values in cortical proximal tubules occurred in the BCLW2 group (p < 0.05 vs. control). These findings suggest that black currant preparations could be valuable functional ingredients. Full article

Ureterolithiasis is a common cause of ureteral obstruction in dogs, often leading to kidney injury. Medical expulsive therapy (MET) using α-adrenergic antagonists has been proposed as a nonsurgical treatment option in selected cases and is thought to facilitate ureteral stone passage by reducing ureteral smooth muscle tone. A 9-year-old castrated male Chihuahua weighing 1.78 kg was presented with anorexia. Physical examination revealed 7% dehydration and pale mucous membranes. Serum biochemistry demonstrated severe azotemia, with markedly elevated symmetric dimethylarginine (>100 μg/dL; reference interval [RI], 0–14 μg/dL), blood urea nitrogen (157.9 mg/dL; RI, 7–25 mg/dL), and creatinine (2.2 mg/dL; RI, 0.5–1.5 mg/dL). On day 4 of hospitalization, ultrasonography revealed dilation of the renal pelvis (16.1 mm), ureteral distention (3.74 mm), and multiple ureteroliths (maximum diameter, 3.31 mm) at the ureterovesical junction. Antegrade pyelography confirmed a right ureteral obstruction. As the owner declined surgical intervention, MET including tamsulosin, was initiated with close clinical monitoring. After 3 days, improvement in azotemia and resolution of ureteral obstruction were observed. Although concurrent medical treatments were administered, this case provides clinical insight into the potential role of tamsulosin as part of medical management of obstructive ureterolithiasis in a dog with small distal ureteral stones. Full article

Background/Objectives: The aim of this study was to develop a modified version of the T.O.HO. score for predicting percutaneous nephrolithotomy (PCNL) success. Materials and Methods: Patient demographics, stone-related parameters, perioperative findings, and postoperative outcomes were recorded. We reviewed the data of 155 patients who underwent percutaneous nephrolithotomy (PCNL) between October 2020 and December 2024. Patients were divided into two groups: success and failure. While preserving the validated components of the existing T.O.HO. score, the stone location parameter was restructured to more accurately reflect the anatomic challenges inherent to PCNL and was scored to include locations in the renal pelvis, upper, middle, lower and multiple calyces. The performance of the T.O.HO.-PCNL score in predicting surgical success was evaluated using ROC curve analysis. Results: The overall success rate was 65.8%. Patients in the successful group had smaller stone sizes and shorter operative times and hospital stays (p < 0.01). Preoperative hydronephrosis was more commonly observed among unsuccessful group (p < 0.05). The T.O.HO.-PCNL score was significantly lower in the successful group compared with the unsuccessful group. (p < 0.05). In the multivariate logistic regression analysis, stone size emerged as an independent predictor of PCNL success (OR: 1.076; 95% CI: 1.032–1.122; p < 0.001). ROC curve analysis demonstrated that the T.O.HO.-PCNL score had predictive value for PCNL success, with an optimal cut-off of 8.5 (AUC: 0.598; 95% CI: 0.506–0.690; p = 0.046). Conclusions: The T.O.HO.-PCNL scoring system is a promising nomogram for predicting stone-free status after PCNL in preoperative evaluation. Full article

Background: Upper tract urothelial carcinoma (UTUC) is a rare malignancy with limited epidemiological data from Central and Eastern Europe. This study aimed to evaluate long-term trends in UTUC incidence, mortality, and survival in Poland and to compare them with other European countries. Methods: Incidence and mortality data were acquired from Polish National Cancer Registry, Statistics Poland and European Cancer Information System. Age-standardized incidence and mortality rates were calculated using the European Standard Population (ESP 2013). Temporal trends were assessed using Joinpoint regression, and five-year relative survival was estimated with the Pohar–Perme method. Results: Our study demonstrated significantly higher incidence and mortality rates of UTUC across Europe compared to the initial observation period, consistent with the data from Poland. UTUC incidence increased in Poland between 2000 and 2017 (average annual percent change [AAPC] 5.6% in women and 9.9% in men), followed by a decline among women after 2017 (AAPC −1.3%). Mortality initially rose in both sexes but decreased in recent years, particularly in men (AAPC −5.47%). Renal pelvis cancer showed higher incidence and mortality than ureteral cancer. Compared with other European countries, Poland exhibited a smaller gap between incidence and mortality. Five-year relative survival improved over time, reaching 55–56% for renal pelvis cancer and up to 62% for ureteral cancer. Conclusions: UTUC incidence and mortality are rising in Europe, but Poland displays a distinctive epidemiological pattern. Strengthening national cancer registries and implementing centralized care protocols may improve disease management and reduce mortality. Full article

Background: Urine cytology is a highly effective, straightforward, and cost-efficient diagnostic tool for identifying neoplastic and non-neoplastic changes in the bladder, ureter, and renal pelvis. The aim of this study is to demonstrate the high sensitivity and specificity of urine cytology in detecting a wide range of urothelial lesions, including metastatic involvement. Material and Methods: Urine cytology was performed on 9639 cases between 2000 and 2025. The samples, collected from patients, were processed at the Institute of Pathology. Cytological slides were prepared using cytocentrifugation and stained with May–Grünwald–Giemsa (MGG) and Papanicolaou stains. The cytological findings were classified according to WHO, 2004 compared with histological specimens. Additionally, selected cases underwent immunohistochemical and molecular analyses. All samples were anonymized and retrospectively analyzed following the guidelines and regulations of the local ethics committee. Results: Of the total cases, 7051 were classified as benign, 1269 as malignant, and 88 as normal findings. Insufficient material was obtained in 336 cases. No complications were reported during sample collection or processing. The concordance with histological findings for neoplastic lesions was over 96%, with a false-negative rate of 1.84%. The diagnostic methods demonstrated a sensitivity of 90.7% and a specificity of 96.64%. Among the 6956 cases analyzed, 3139 were women (45.13%) and 3817 were men (54.87%). Conclusions: The diagnostic value of urine cytology in representative material is relatively high in assessing both the presence or absence of malignancy and, when applicable, the tumor grade. This large 25-year single-center review demonstrates that urine cytology retains high sensitivity and specificity for the detection of urothelial malignancy, particularly high-grade disease. However, the atypical category remains a major diagnostic challenge and contributes substantially to false-positive results. Full article

Brown tumors (BTs) are rare osteolytic lesions that typically occur in association with primary or secondary hyperparathyroidism (PHP and SHP). Excessive secretion of parathyroid hormone induces increased bone resorption, resulting in lesions characterized by fibrosis, vascularization, and hemosiderin deposition. The most common sites include the jaws, ribs, pelvis, and long bones. Clinical manifestations may involve pain, swelling, or pathological fractures. We present the case of a mandibular BT in a 48-year-old female with chronic renal failure and secondary hyperparathyroidism. The patient exhibited progressive mandibular swelling with radiological features resembling an aggressive odontogenic or malignant lesion. Laboratory analysis confirmed markedly elevated parathyroid hormone levels, while scintigraphy demonstrated increased focal uptake in the mandible and ribs. Histopathological evaluation revealed multinucleated giant cells within a fibrous stroma, consistent with BT. Despite initiation of systemic endocrine therapy, the lesion continued to enlarge, necessitating complete surgical excision of the mandibular mass. This case underscores the diagnostic dilemmas of mandibular BT, which may closely mimic aggressive jaw pathologies. Importantly, while many BTs regress after systemic management of hyperparathyroidism, this case illustrates that surgical excision may be unavoidable in patients with unstable systemic status or progressive local disease. Comprehensive clinical, radiological, laboratory, and histopathological evaluation remains essential to ensure timely diagnosis and appropriate treatment. Full article

Background and Clinical Significance: Mucinous tubular and spindle cell carcinoma (MTSCC) is an uncommon subtype of renal cell carcinoma, representing 1–4% of epithelial renal tumors. It usually shows a low-grade morphology and indolent behavior, although sarcomatoid variants with an aggressive course have been described. Because of its overlap with papillary renal cell carcinoma (papRCC), sarcomatoid RCC, mesenchymal tumors, and oncocytic neoplasms, diagnosis requires the integration of imaging, histopathology, and immunohistochemistry. Case Presentation: We report a 71-year-old female who presented with a three-month history of right-sided lumbar pain and intermittent hematuria. Her laboratory tests were unremarkable. Contrast-enhanced CT revealed a well-circumscribed nodular lesion in the mid-portion of the right kidney, measuring 50 × 47 × 52 mm. The patient underwent right nephrectomy. Macroscopic findings revealed an encapsulated, yellowish-gray nodule (5.2 × 5 × 4 cm) without renal pelvis invasion. Microscopically, the tumor consisted of cuboidal- to spindle-shaped cells arranged in cords and tubular structures within a mucinous stroma, with focal necrosis and foamy macrophages. Immunohistochemistry showed positivity for CK19, CK7, EMA, PAX8, and AMACR, with a Ki-67 index <10%, while CD117, RCC, CD10, and chromogranin were negative. Together, the low Ki-67 proliferation index, absence of invasion, and low-grade histological architecture confirmed MTSCC of low malignant potential. At a five-year follow-up, the patient remained disease-free. Conclusions: MTSCC is a rare renal neoplasm that can be diagnosed by integrating clinico-radiological, histopathological, and immunophenotypic features. Molecular profiling may further distinguish MTSCC from papRCC and identify aggressive variants. Surgical excision remains the cornerstone of management, supported by vigilant long-term follow-up. Full article