Search Results (253)

Background: Spontaneous rectus sheath hematoma is a known but relatively rare complication of anticoagulant therapy. Because its clinical features are similar to various intra-abdominal pathologies, it is often misdiagnosed as other types of acute abdomen in emergency settings. Case Presentation: The patient presented with acute lower abdominal pain, suprapubic distension, and sudden anuria following anticoagulation therapy. Abdominal computed tomography revealed a giant pelvic mass mimicking a distended bladder, suggestive of bladder tamponade. A percutaneous cystostomy was then performed, which, however, drained a large volume of non-clotted blood rather than blood clots. Subsequent radiological and clinical evaluation confirmed a giant spontaneous rectus sheath hematoma. Given the patient’s critical condition and poor prognosis, after thorough discussion with the family, the decision was made to transfer the patient to a local hospital for continued supportive care. Conclusions: This case highlights the diagnostic challenges of giant or atypically located rectus sheath hematomas, which may clinically and radiologically mimic intra-abdominal or urological emergencies such as bladder tamponade. Conventional clinical evaluation and erroneous radiological interpretation can lead to a misdiagnosis, occasionally resulting in inappropriate invasive interventions. Recognizing specific radiological signs, such as internal fluid layering and extravesical catheter placement, combined with multiplanar computed tomography reconstruction, helps minimize diagnostic pitfalls, prevent unnecessary procedures, and optimize clinical outcomes. Full article

Background: Supine flexible cystoscopy is already established in routine urological practice. However, real-world patient-reported pain across specific procedural stages and other patient-centered outcomes according to clinician-selected procedural position remain incompletely characterized. This study evaluated the associations of supine and lithotomy positioning with patient-reported and procedural outcomes in adult men undergoing flexible cystoscopy. Materials and Methods: This multicenter retrospective observational study included 80 adult male patients who underwent flexible cystoscopy under local anesthesia. Procedural position was selected by the treating urologist according to clinical feasibility and routine clinical judgment, including the patient’s ability to assume the lithotomy position. Patients were classified according to the position used during the procedure as supine (n = 40) or lithotomy (n = 40). Pain was assessed using a 0–10 Visual Analog Scale (VAS), with higher scores indicating greater pain. Patient satisfaction was assessed using a separate 0–10 scale. Secondary outcomes included procedure duration, procedural success, complication rates, and patient tolerance. Procedural tolerance and overall patient satisfaction were assessed immediately after cystoscopy using separate single-item 0–10 rating scales. For the satisfaction scale, 0 indicated “completely dissatisfied” and 10 indicated “completely satisfied”. Group comparisons and an exploratory multivariable linear regression analysis of the primary pain outcome were performed. Results: A total of 80 patients were included (40 supine and 40 lithotomy). Mean VAS scores were lower in the supine group during cystoscope insertion (2.1 ± 1.0 vs. 3.4 ± 1.2; mean difference [MD]: −1.30, 95% CI: −1.79 to −0.81; p < 0.001), bladder evaluation (1.8 ± 0.9 vs. 2.6 ± 1.1; MD: −0.80, 95% CI: −1.25 to −0.35; p = 0.001), and immediately after the procedure (1.2 ± 0.7 vs. 2.0 ± 0.9; MD: −0.80, 95% CI: −1.16 to −0.44; p < 0.001). Procedure duration was 6.8 ± 2.1 versus 7.4 ± 2.3 min (MD: −0.60 min, 95% CI: −1.58 to 0.38; p = 0.186). Procedural success occurred in 97.5% versus 95.0% of patients (risk difference [RD]: 2.5 percentage points, 95% CI: −8.5 to 14.2; p = 1.000). In an exploratory post hoc subgroup of patients with documented difficult catheterization (n = 40; 20 patients per group), cystoscopy-guided catheterization was successful in 19/20 patients (95.0%) in the supine group and 13/20 patients (65.0%) in the lithotomy group (RD: 30.0 percentage points, 95% CI: 4.9 to 52.1; p = 0.044). This small, non-prespecified subgroup analysis was considered hypothesis-generating. Complications occurred in 4/40 patients (10.0%) in the supine group and 7/40 patients (17.5%) in the lithotomy group (RD: −7.5 percentage points, 95% CI: −23.2 to 8.2; two-sided Fisher’s exact p = 0.518). Procedural tolerance (8.6 ± 1.1 vs. 7.2 ± 1.4; MD: 1.40, 95% CI: 0.84 to 1.96; p < 0.001) and overall satisfaction scores (8.8 ± 1.0 vs. 7.4 ± 1.3; MD: 1.40, 95% CI: 0.88 to 1.92; p < 0.001) were higher in the supine group. After adjustment for the available covariates, supine positioning remained associated with a lower insertion-related VAS score (β = −1.21, 95% CI: −1.75 to −0.67; p < 0.001). Conclusions: In this retrospective, non-randomized cohort, clinician-selected supine positioning was associated with lower reported pain and higher procedural tolerance and satisfaction compared with lithotomy positioning. No statistically significant between-group differences were observed in overall procedural success or complication rates. Because position selection was clinician-directed and potentially influenced by patient mobility and other unmeasured factors, these findings do not demonstrate a causal benefit of supine positioning. They should be considered hypothesis-generating and require confirmation in adequately powered prospective randomized studies before informing changes in routine clinical practice. Full article

Objectives: The aim of this study was to evaluate the reliability, accuracy, and morbidity of dynamic sentinel lymph node biopsy (DSNB) in patients with intermediate- and high-risk penile cancer who had clinically negative lymph nodes, with a focus on long-term follow-up outcomes. Methods: Between January 2005 and January 2024, 287 patients with histologically confirmed penile cancer underwent radioisotope-guided DSNB at the Department of Urology, University of Pécs. Patients lost to follow-up within 24 months were excluded. Of the remaining patients, 211 underwent primary DSNB and 37 secondary DSNB. Thirty-nine patients in the primary DSNB group with Tis, T1a, or G1 tumours were additionally excluded, leaving 209 patients for analysis. Variables included tumour stage and grade, sentinel lymph node (SLN) yield and histology, complications, inguinal progression, false-negative rate, and radical lymphadenectomy findings. Results: A total of 573 SLNs were removed from 209 patients, with a median of 2.7 nodes per patient. SLN metastases were identified in 31 patients, involving 37 groins. Among 178 patients with negative SLNs, three developed inguinal metastases. Sensitivity was 91% per patient and 92.5% per groin, with false-negative rates of 8% and 7.5%, respectively. All false-negative cases occurred within two years, with no later inguinal recurrences. DSNB-related complications occurred in 24 patients (11.4%); most were mild or moderate and managed on an outpatient basis. Two patients required surgery and one required hospital readmission. Conclusions: In a high-volume centre, DSNB is a safe and reliable staging procedure with low morbidity in clinically node-negative intermediate- and high-risk penile cancer. Further studies should assess radiotracer injection sites and compare one-day versus two-day protocols. Full article

Objectives: This study aimed to explore the cellular injury phenotypes induced by outer membrane vesicles (OMVs) from uropathogenic Escherichia coli (E. coli, UPEC) and Proteus mirabilis (P. mirabilis, P. m) in human renal tubular epithelial HK-2 cells in vitro. Introduction: In urological practice, UPEC and P. mirabilis are representative pathogens of uncomplicated and complicated UTIs, respectively. Both are Gram-negative bacteria, and a notable feature of these bacteria is their ability to secrete OMVs. OMVs are nanoscale vesicles containing lipopolysaccharides (LPS), phospholipids, peptidoglycan, nucleic acids, and various virulence factors such as proteases and toxins. OMVs serve as effective carriers, delivering these toxic substances to host cells, triggering inflammatory responses, cellular damage, and ultimately cell death. Methods: In this study, we cultured standard pathogenic strains of E. coli and P. mirabilis in lysogeny broth (LB) medium until they reached the logarithmic growth phase. OMVs were isolated and identified. The uptake of OMVs by HK-2 cells was observed in vitro, and we evaluated the cytotoxic effects of both types of OMVs by measuring cell viability, oxidative stress, membrane permeability, mitochondrial function, and organelle morphology. Results: The results demonstrated that OMVs from both bacterial strains were efficiently internalized by HK-2 cells. Both OMVs induced oxidative stress, decreased antioxidant capacity, disrupted membrane permeability, and damaged mitochondrial function, leading to cell injury. Interestingly, while the two types of OMVs caused comparable cytotoxicity in terms of cell viability, oxidative stress and mitochondrial membrane potential, they produced distinct patterns of mitochondrial ultrastructural injury: P. mirabilis OMVs primarily caused mitochondrial structural deformation and blurred cristae, while E. coli OMVs led to mitochondrial swelling, cristae breakage, and vacuolization. These findings provide phenotypic evidence and experimental clues for understanding OMV-associated renal tubular epithelial injury caused by different uropathogens. Full article

Background/Objectives: Double-J (DJ) ureteral stents are prone to luminal occlusion, which causes renal dysfunction and complicates exchange. Risk stratification in chronically stent-dependent patients is poorly defined, and the management of confirmed occlusion is not standardised. We aimed to identify independent risk factors for DJ stent occlusion in a chronically stent-dependent population and to evaluate stent-type substitution at first confirmed occlusion. Methods: We conducted a single-centre retrospective cohort study at a tertiary urology service in Melbourne, Australia (January 2023 to December 2025). Patients requiring three or more sequential DJ replacements were eligible. Mechanical occlusion was defined as inability to pass a guidewire through the stent lumen at fluoroscopic exchange, an objective intraoperative surrogate; clinical failure events (nephrostomy conversion, septic admission, or acute kidney injury requiring intervention) were recorded separately. Midstream urine culture and pre-exchange renal ultrasound were obtained at each visit. Cox proportional hazards modelling with robust patient-level clustering was performed. Results: We analysed 125 ureters (97 patients) over a mean follow-up of 20.6 months. Occlusion occurred in 55 ureters (44.0%). Four predictors were robust to Bonferroni correction: indwelling urethral catheter (hazard ratio [HR] 4.62), urinary stone disease versus malignant disease (HR 4.02), retroperitoneal fibrosis versus malignant disease (HR 3.24), and bacteriuria at exchange (HR 2.76). Two further associations, Eastern Cooperative Oncology Group (ECOG) performance status 2 to 4 (HR 2.31) and prior pyelonephritis (HR 1.89), did not survive correction and are exploratory. After stent-type substitution at first occlusion, 43 of 55 ureters (78.2%) had no further occlusion without interval shortening. Summer accounted for 45.1% of events (p < 0.001). Conclusions: In chronically stent-dependent patients, several factors were independently associated with DJ stent occlusion, four of them robust to multiple-comparison correction. Stent-type substitution was associated with occlusion-free outcomes in most cases without interval shortening; because the analysis was uncontrolled and regression to the mean cannot be excluded, this observation is hypothesis-generating. All hazard estimates are exploratory in view of an events-per-variable ratio below ten and a survivor-selected cohort, and apply only to patients with established chronic stent dependency. Prospective randomised evaluation is warranted. Full article

Background and Clinical Significance: Ruptured common iliac artery aneurysms may mimic urological disease, particularly when retroperitoneal bleeding causes ureteral compression and secondary hydronephrosis. This case is clinically relevant because the first symptom was acute stabbing testicular pain, followed by lumbar discomfort and ultrasound findings suggestive of obstructive uropathy. Case Presentation: A 73-year-old man with arterial hypertension and active smoking presented to the Emergency Department with sudden left lumbar pain that initially radiated to, or was perceived in, the left testicle. The testicular pain resolved spontaneously, but persistent poorly localized lumbar pain continued. He was afebrile and initially hemodynamically stable. Point-of-care ultrasound showed left hydronephrosis, while the abdominal aorta appeared unremarkable. Because the patient looked clinically unwell and the abrupt, stabbing onset was not fully explained by uncomplicated renal colic, contrast-enhanced abdominal and pelvic computed tomography was performed. CT revealed a fissured saccular aneurysm of the left common iliac artery with active contrast extravasation and a large retroperitoneal hematoma compressing the ipsilateral ureter, thereby causing secondary hydronephrosis. The patient underwent urgent endovascular treatment with percutaneous transluminal angioplasty and Bentley stent. Post-revascularization CT showed no further contrast extravasation, and the patient was discharged after seven days without complications. Conclusions: In older patients with cardiovascular risk factors, sudden testicular, flank, or lumbar pain may warrant consideration of retroperitoneal vascular emergencies, even when initial ultrasound suggests a urological diagnosis. In this patient, discordance between the clinical presentation and the initial ultrasound findings prompted contrast-enhanced CT, which enabled diagnosis and timely vascular management. Full article

Background: Prostate cancer patients with intermediate disease risk [Gleason score (GS)7] can be divided into two groups: GS = 7(3 + 4) (ISUP 2) (favorable disease risk) and GS = 7(4 + 3) (ISUP 3) (unfavorable disease risk). Low-dose-rate brachytherapy (LDR-BT) is an effective treatment for low- and intermediate-disease-risk patients. Objectives: The main goal of this study was to evaluate the effectiveness of LDR-BT monotherapy in prostate cancer patients classified as ISUP 3 when compared with ISUP 2 patients. Methods: This was a retrospective study that evaluated prostate cancer patients classified as ISUP 2 and ISUP 3 followed up at the Center for the Treatment of Urological Diseases, Portugal, who underwent LDR-BT. Overall survival (OS), biochemical recurrence-free survival (BRFS), bone metastasis and complications post-LDR-BT treatment were evaluated. Results: A total of 602 patients classified with GS = 7 (481/602 ISUP 2 and 121/602 ISUP 3) treated with LDR-BT were recruited. High OS rates and a reduced frequency of complications were described in both groups of patients. ISUP 3 patients had a lower BRFS rate, a higher risk of biochemical recurrence, and developed more bone metastasis in a shorter period when compared with ISUP 2 patients. No significant differences were detected in prostate-cancer-specific mortality between groups. Conclusions: LDR-BT monotherapy is a safe and effective treatment for prostate cancer patients with favorable and unfavorable intermediate disease risk, with similar OS rates and reduced complications. Full article

Cardiovascular complications increasingly challenge survivors of urological cancers, given the cardiotoxicity of therapies such as androgen deprivation, vascular endothelial growth factor receptor inhibitors, tyrosine kinase inhibitors, immune checkpoint inhibitors, and chemotherapy. This narrative review addresses the complex crosstalk between urological cancer treatment and cardiovascular disease. It summarizes cardiovascular toxicities linked to major antineoplastic agents, explores underlying mechanisms including metabolic and immune-mediated effects, and proposes strategies for surveillance, diagnosis, and management. Highlighting the need for multidisciplinary collaboration, it outlines future directions for research to optimize cardiovascular outcomes in this high-risk population. The increasing complexity of cardiovascular care in patients with urological malignancies highlights the need for closer collaboration between cardiologists, urologists, and oncologists, with uro-cardio-oncology emerging as an important multidisciplinary field. Full article

Background: Elderly and frail patients undergoing surgery for urological cancer have increased vulnerability to postoperative complications, delayed recovery, and functional decline. The da Vinci Single-Port (SP) platform may reduce surgical stress by enabling regionalized extraperitoneal, retroperitoneal, or transvesical access through a single incision. Objective: The objective was to provide a narrative review of the comparative evidence on da Vinci SP versus conventional multi-port (MP) robotic surgery in elderly or frail urological cancer patients. Methods: A structured search was performed to identify comparative studies reporting outcomes in patients defined as elderly by chronological age (≥65 years) or as frail by a validated frailty index. Findings are reported separately according to the vulnerability construct that was actually measured. Because of procedural and methodological heterogeneity, a narrative synthesis was performed, and the risk of bias was appraised qualitatively along the domains of the ROBINS-I tool. Results: Only three retrospective comparative studies are currently available: two on robot-assisted radical prostatectomy (one in patients aged ≥65 years and one in patients stratified by the 5-item modified frailty index) and one on robot-assisted partial nephrectomy in patients aged ≥65 years. Across these studies, SP surgery was associated with fewer early postoperative complications, shorter length of stay, and more favourable recovery-related endpoints, and in the frailty-stratified study the apparent protective effect increased with frailty burden. All estimates are those published by the original authors, are reported descriptively, and were not pooled. Importantly, in none of the three studies was the SP platform compared with MP surgery performed through the same access route: SP procedures were predominantly extraperitoneal or retroperitoneal and MP procedures were predominantly transperitoneal, so the effect of the platform cannot be separated from that of the access route. Conclusions: The available data are compatible with a reduction in early perioperative morbidity after SP robotic surgery in selected elderly or frail urological cancer patients, particularly when the platform enables extraperitoneal or retroperitoneal access. Because this evidence rests on three retrospective studies at serious risk of bias, the findings are preliminary and hypothesis-generating rather than confirmatory. Prospective studies incorporating geriatric screening, validated frailty metrics, patient-reported recovery, cost-effectiveness, and long-term oncological outcomes are needed. Full article

Objectives: Hypospadias is one of the most common congenital malformations of the male genitourinary system, and postoperative complications remain a major concern affecting surgical outcomes and patients‘ quality of life. Whether machine learning models can effectively predict complication risk using routinely available clinical variables remains unclear. Methods: A retrospective analysis was performed on 671 hypospadias patients who underwent urethroplasty at the Department of Urology, Capital Children’s Medical Center, between December 2015 and September 2024. The final dataset included 671 patients (training set: 536; validation set: 135). The median follow-up duration was 48 months (range: 19 to 72 months). Least absolute shrinkage and selection operator (LASSO) regression with nested cross-validation within the training set was used for feature selection, followed by the development of five machine learning models (Random Forest, XGBoost, LightGBM, Logistic Regression, and Support Vector Machine). Model performance was evaluated using AUC, calibration curves, Brier score, and decision curve analysis. Feature importance was assessed using SHapley Additive exPlanations (SHAP). Results: LASSO retained four features for model development: hypospadias type, surgical technique, surgeon experience, and patient age. The overall complication rate was 22.9% (154/671). Among the models evaluated, the Support Vector Machine (SVM) showed the most balanced performance in the validation set, achieving an AUC of 0.810 and a Brier score of 0.157. LightGBM demonstrated comparable performance (AUC: 0.802). SHAP analysis identified surgical technique as the most influential predictor, followed by surgeon volume and hypospadias type, though these findings should be interpreted with caution given the confounding between surgical complexity and disease severity. Conclusions: An interpretable SVM-based prediction model was developed and internally validated to stratify risk for postoperative complications after hypospadias repair using routinely available clinical variables. SHAP provided clinicians with visual insights into key risk-associated factors. However, given the single-center retrospective design and lack of external validation, further multicenter prospective studies are warranted to confirm the generalizability of these findings before clinical implementation. Full article

Objectives: Prenatal diagnosis of horseshoe kidney (HSK), a common congenital renal fusion anomaly of the upper urinary tract, remains challenging. Most cases are identified only after birth; however, the clinical significance of prenatal detection and its impact on postnatal outcomes remains unknown. Methods: We investigated infants with postnatally confirmed HSK born at a tertiary referral center between January 2009 and August 2025. Prenatal ultrasonographic findings and postnatal outcomes were reviewed. Patients were classified into three groups according to prenatal detection status: missed HSK (group 1), prenatally detected renal abnormalities without recognition of HSK (group 2), and prenatally identified HSK (group 3). Perinatal outcomes, postnatal urological complications, renal function, and associated anomalies were compared. Results: Overall, 29 infants were included in this study. Perinatal outcomes, including gestational age at delivery, birth weight, preterm birth, Apgar scores, need for ventilatory support, and neonatal sex, did not differ significantly among the groups. Hydronephrosis and renal scarring were more frequently observed in group 2 than in the other groups. Other urological outcomes, renal function parameters, and mortality rates were comparable between the groups. Conclusions: This adds to the limited longitudinal evidence linking the prenatal to postnatal period and evaluating the full spectrum of prenatal detection in HSK, as well as its association with postnatal outcomes. Postnatal outcomes are closely associated with the presence of renal abnormalities. Therefore, prenatal imaging is more appropriate for identifying associated renal abnormalities than for establishing a definitive diagnosis of HSK. Full article

Background: Prostate cancer represents one of the greatest challenges in modern urology. The definitive diagnosis relies on prostate biopsy. The traditional transrectal (TR) approach carries a significant risk of infectious complications and drives antimicrobial resistance. For this reason, the transperineal (TP) approach is increasingly being considered the method of choice. This literature review aims to comparatively analyze both methods (TP vs. TR) in terms of oncological efficacy, infectious and non-infectious safety, patient-reported pain tolerance, and cost-effectiveness. Materials and Methods: A comprehensive search of the PubMed and Embase databases was conducted, including English-language clinical studies published after 2011. Studies directly comparing TP and TR biopsies regarding diagnostic parameters and/or complication profiles were eligible for inclusion and subsequently underwent qualitative methodological assessment. Additionally, to outline a broader background and fuller clinical context, other supplementary publications were included in the review. Results: Ultimately, 14 publications representing 10 unique clinical trials were included in the main analysis. The overall cancer detection rate is comparable for both methods; however, the TP approach demonstrates an advantage in detecting anterior zone lesions and—especially in combination with MRI—clinically significant prostate cancer (csPCa). Both techniques differ in their safety and tolerance profiles: TP minimizes the risk of infection and rectal bleeding but is associated with higher short-term discomfort during local anesthesia administration and more frequent hematuria. Conversely, TR is associated with prolonged post-procedural discomfort. Economic analyses yield inconclusive results depending on the time horizon adopted. Conclusions: The choice of biopsy technique requires a conscious clinical compromise. The TP method is becoming the preferred option due to its more favorable infectious safety profile. The development of modern urology should aim towards fully personalized diagnostics, where the decision regarding the biopsy approach is based on the patient’s best interest and is individually tailored to their anatomy, risk profile, and personal preferences. Full article

Background/Objectives: Iatrogenic nerve injury is a significant challenge in urologic surgery, with radical prostatectomy posing a high risk due to complex pelvic neural anatomy. Despite advances in robotic-assisted and nerve-sparing techniques, postoperative urinary incontinence and erectile dysfunction remain prevalent, adversely affecting patients’ quality of life and imposing substantial healthcare costs. Methods: A narrative review was conducted using PubMed, MEDLINE, and the Cochrane Library (searches through February 2026) for studies on radical prostatectomy epidemiology, mechanisms of nerve injury, functional outcomes, and economic burden. Emerging intraoperative fluorescence imaging technologies, surgical strategies to mitigate iatrogenic nerve injuries, and the financial costs of post-prostatectomy complications were assessed. Results: Robotic-assisted radical prostatectomy now accounts for >80% of procedures in the United States, and has been associated in observational studies with improved early recovery of erectile function compared with open and laparoscopic approaches. However, the lack of real-time nerve visualization remains a limiting factor. Recent milestones (January 2026) include the Food and Drug Administration Investigational New Drug clearance for the nerve-specific fluorophore LGW16-03 (NerveTrace), which enables real-time identification of sub-millimeter nerve branches, and the 510(k) premarket clearance of Dendrite imaging (November 2025). Conclusions: Enhanced intraoperative nerve discrimination via molecularly targeted imaging has the potential to reduce iatrogenic complications and improve long-term functional and economic outcomes in prostate cancer surgery, although these benefits have yet to be demonstrated in prospective clinical and health-economic studies. Full article

The introduction of minimally invasive surgery (MIS) marked a turning point in the history of medicine, driving one of the sharpest declines in surgical mortality and morbidity ever recorded—saving millions of lives and sparing an estimated one billion patients the suffering once inherent to large-incision surgery. Within a single generation, this once highly contested surgical innovation became the global standard of care, transforming surgical practice across disciplines and on a global scale. By every measure of public health, these outcomes place modern minimally invasive and robotic-assisted surgery as among the most consequential life-saving advances in modern medical history. This review examines the clinical impact and global dissemination of MIS, tracing its evolution from Camran Nezhat’s pioneering expansion of laparoscopy beyond diagnostics to complex therapeutic procedures across surgical disciplines. Drawing on decades of evidence across gynecology, general surgery, and urology, we show that MIS is associated with substantial reductions in perioperative mortality, major complications, blood loss, infections, thromboembolic events, postoperative pain, and length of hospital stay, while maintaining oncologic equivalence and improving functional and quality-of-life outcomes. Beyond these technical advances, MIS catalyzed a broader reimagining of surgery itself, challenging long-standing norms rooted in large-incision approaches and shifting the field toward precision, organ preservation, and pathology-directed intervention. These changes were accompanied by parallel advances in multiple domains, including in imaging, intraoperative visualization technologies, surgical anatomy, instrumentation, and nerve- and organ-sparing techniques—developments that collectively established the foundation for contemporary minimally invasive and robotic-assisted surgery. Collectively, these advances have contributed to the prevention of an estimated 10–20 million surgery-related deaths that would likely have occurred under the large-incision approaches of the past. Full article

Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic relapsing–remitting condition characterized by systemic and intestinal inflammation and immune dysregulation. Up to 47% of IBD patients develop extraintestinal manifestations, yet kidney and urological involvement remain underrecognized. Accumulating evidence has linked IBD to nephrolithiasis, glomerular diseases, tubulointerstitial nephritis, acute kidney injury, chronic kidney disease, and, rarely, amyloid A amyloidosis. Population studies have consistently shown elevated risks for various important kidney disorders in IBD, with CD generally posing a greater risk than UC. The pathogenesis of kidney complications in IBD reflects complex gut–kidney interactions, including metabolic and absorptive abnormalities, shared genetic and immune pathways, intestinal dysbiosis with nephrotoxic microbial metabolites, systemic inflammation, and drug-related nephrotoxicity. Strategies for kidney protection in IBD include increased awareness, close monitoring of kidney function, urinary metabolic profiling in high-risk patients, and prompt nephrology referral for early detection and treatment. Management should include an effective and sustained control of intestinal inflammation, discontinuation of potential nephrotoxic drugs when indicated, and timely diagnosis and treatment of kidney manifestations, as well as integrating kidney complications into IBD guidelines to enhance awareness, ultimately optimizing both the kidney and overall outcomes for IBD patients. Future studies are needed to validate the potential predictive biomarkers for kidney complications and to develop targeted interventions to address shared gut–kidney pathogenic mechanisms in IBD. Full article