Urology Journal

Purpose: This study aimed to compare and evaluate the functional outcomes and safety of ileal neobladder and
colonic neobladder (sigmoid and ileocecal subtypes) after radical cystectomy.
Materials and Methods: A systematic literature search was conducted across PubMed, Web of Science, and
Embase following the PRISMA 2020 guidelines. Subgroup analyses compared ileal neobladder with sigmoid neobladder and ileocecal neobladder. Study quality was evaluated using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale, and evidence certainty was evaluated using the GRADE approach. Continuous and dichotomous variables were analyzed using weighted mean differences and risk ratios with 95% confidence intervals.
Results: Seventeen studies (one randomized controlled trial and 16 cohort studies) were included. Early postoperative complications were significantly less frequent with ileal neobladder than with sigmoid neobladder, with no significant difference between ileal and ileocecal neobladders. Late complications and daytime continence were comparable among all groups. Ileal neobladder achieved significantly superior nighttime continence compared with colonic neobladders. However, ileal neobladder was associated with higher postvoid residual urine volume and higher clean intermittent catheterization rates than sigmoid neobladder, with similar voiding outcomes between ileal and ileocecal neobladders.
Conclusion: Ileal neobladder provides superior nighttime urinary continence and lower early complication rates
compared with sigmoid neobladder, whereas sigmoid neobladder provides better spontaneous voiding performance. Given the observational nature of available evidence and notable heterogeneity, no single pouch type is universally superior, and individualized surgical selection is recommended.

Purpose: Large proximal ureteral stones (>1 cm) present significant therapeutic challenges due to high complication risks and technical complexities. Current guidelines provide no clear preference between ureteroscopic lithotripsy and laparoscopic ureterolithotomy for large proximal ureteral stones, and the optimal surgical approach remains debated. This meta-analysis therefore compares the clinical efficacy and safety of ureteroscopy versus laparoscopic ureterolithotomy using randomized controlled trial (RCT) data.
Materials and Methods: We systematically searched PubMed, Cochrane Library, Embase, Web of Science,
CNKI, Wanfang, VIP, and China Biomedical Literature Database from their inception to July 12, 2026, for RCTs
comparing the clinical efficacy of ureteroscopy and laparoscopic ureterolithotomy for large proximal ureteral calculi
(>1 cm). Data from the included RCTs were statistically analyzed using Review Manager 5.2 software.
Results: A total of 11 RCTs involving 1300 patients were included. Laparoscopic ureterolithotomy showed significantly higher immediate (odds ratio [OR] = 8.06, P < .001) and final (OR = 8.56, P < .001) stone-free rates, but
longer operative time (standardized mean difference [SMD] = 1.28, P = .01), longer hospital stay (SMD = 1.67, P
< .001), and higher postoperative pain scores (SMD = 0.76, P < .001) compared with ureteroscopy. Postoperative
complication rates were significantly lower with laparoscopic ureterolithotomy (OR = 0.43, P < .001).
Conclusion: Laparoscopic ureterolithotomy provides higher stone-free rates and fewer complications for large
proximal ureteral stones, but entails longer operative time, extended hospitalization, and increased postoperative
pain. However, the pooled estimates predominantly derive from older trials lacking contemporary ureteroscopic
technologies (e.g., high-power lasers, suction access sheaths). Thus, laparoscopic ureterolithotomy represents a
viable alternative primarily where modern ureteroscopic equipment is unavailable or contraindicated.

Purpose: To update and expand clinical evidence comparing allograft and recipient survival as well as perioperative complications between ABO-incompatible and center-matched or concurrent ABO-compatible kidney transplant recipients.
Materials and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, PubMed, Scopus, and Embase were searched from 2010 through December 2024 using prespecified Medical Subject Headings (MeSH) terms. Observational cohort and registry studies reporting patient survival, graft survival, or rejection episodes were included. Initial screening was restricted to English-language publications. Methodological quality was appraised via the Newcastle-Ottawa Scale. Random-effects and fixed-effects models were applied to calculate pooled risk ratios with 95% confidence intervals. Meta-regression, publication bias assessments, and confounding evaluations were allocated to supplementary files owing to data sparsity across unadjusted subsets.
Results: Data from 63 observational studies (5,852 ABO-incompatible and 47,950 ABO-compatible recipients) were synthesized. ABO-incompatible transplantation was associated with higher risks of overall rejection (risk ratio = 1.28, 95% confidence interval: 1.17–1.40) and antibody-mediated rejection (risk ratio = 2.14, 95% confidence interval: 1.48–3.09), whereas T-cell-mediated rejection showed comparable intervals (risk ratio = 0.86, 95% confidence interval: 0.72–1.04). Short- and long-term patient and graft survival estimates (at 1, 3, and 10 years) demonstrated wide compatibility between cohorts. However, 5-year patient survival showed lower compatibility with the null, favoring ABO-compatible transplants (risk ratio = 1.62, 95% confidence interval: 1.13–2.32). Surgical complications and postoperative bleeding were markedly higher in ABO-incompatible recipients.
Conclusion: ABO-incompatible kidney transplantation provides valuable expanded organ access with comparable 1-, 3-, and 10-year survival estimates, but carries elevated risks of rejection, early bleeding, and infections, alongside a noted divergence in 5-year patient survival.

Purpose: There is a growing need for rapid, simple, and cost-effective biomarkers that facilitate early risk stratification in patients with severe upper urinary tract infections. This study aimed to investigate whether the systemic immune-inflammation index (SII) and neutrophil-to-platelet ratio (NPR) at hospital admission can predict the need for intensive care unit (ICU) admission and the duration of hospitalization in patients with acute obstructive pyelonephritis managed with percutaneous nephrostomy.
Materials and Methods: Patients aged ≥18 years who were hospitalized with acute obstructive pyelonephritis
and underwent emergency percutaneous nephrostomy between June 19, 2020, and July 30, 2025, were evaluated
retrospectively. A comparative analysis was conducted between patients who required ICU admission and those
who did not. Admission SII and NPR were calculated, and their associations with ICU requirement and length of
hospital stay were analyzed using multivariable logistic and linear regression models, receiver operating characteristic curves, and the Youden index.
Results: A total of 440 patients were analyzed, of whom 29 required ICU care. Patients requiring ICU admission
exhibited significantly higher median SII, NPR, leukocyte counts, neutrophil counts, and procalcitonin levels,
along with lower hemoglobin and lymphocyte concentrations. In multivariable logistic regression adjusted for
class imbalance, elevated SII independently predicted ICU admission (odds ratio, 1.70; 95% confidence interval,
1.34–2.17; P < .001). Admission SII was positively associated with the duration of hospital stay (β = 0.184; P < .001).
Conclusion: SII represents an accessible, cost-effective biomarker for early identification of patients at heightened
risk of clinical deterioration requiring ICU transfer and prolonged hospitalization in acute obstructive pyelonephritis.

Purpose: Prostate-specific antigen (PSA) progression does not always coincide with radiographic progression in
patients with metastatic castration-sensitive prostate cancer (mCSPC) receiving upfront androgen receptor signaling inhibitor (ARSI) therapy. We evaluated the timing of radiographic progression according to predefined PSA
kinetic periods.
Materials and Methods: We retrospectively reviewed 82 consecutive patients with synchronous mCSPC treated
with upfront ARSI therapy between April 2018 and May 2024. The median follow-up duration was 23 months
(interquartile range [IQR], 14–38). PSA kinetics were categorized into three predefined periods: pre-PSA nadir
(treatment initiation to PSA nadir), post-PSA nadir/before PSA progression (PSA nadir to PSA progression), and
post-PSA progression. Radiographic progression events were classified according to these PSA kinetic periods.
Results: During follow-up, 33 patients (40%) experienced PSA progression and 26 (31.7%) developed radiographic
progression. Among the 26 radiographic progression events, 1 (3.8%) occurred during the pre-PSA nadir
period, 7 (26.9%) during the post-PSA nadir/before PSA progression period, and 18 (69.2%) during the post-
PSA progression period. Overall, 25 of 26 radiographic progression events (96.2%; 95% confidence interval [CI]:
81.1%–99.3%) occurred after PSA nadir. The only patient who developed radiographic progression before PSA
nadir was subsequently diagnosed with small-cell carcinoma of the prostate. PSA nadir levels and time to PSA nadir
were comparable between patients who developed radiographic progression before and after PSA progression.
Conclusion: Radiographic progression before PSA nadir was uncommon in this cohort, whereas a substantial
proportion of progression events occurred after PSA nadir but before PSA progression. These findings suggest
that PSA nadir may serve as a useful temporal reference point for radiographic surveillance during upfront ARSI
therapy. However, these observations should be considered hypothesis-generating and require validation in larger
prospective multicenter studies.

Purpose: Currently, the risk factors for bladder diverticula in patients with benign prostatic enlargement remain
unclear. Therefore, this study aimed to identify independent risk factors and provide a clinical reference for early
risk screening of this complication.
Materials and Methods: A total of 310 patients diagnosed with benign prostatic enlargement between January
2021 and December 2024 were included in this retrospective study. General clinical data and relevant clinical
indicators were collected, and risk factors were identified through univariate and multivariate logistic regression
analyses.
Results: Among the 310 patients with benign prostatic enlargement, 21 had bladder diverticula, representing an
incidence of 6.77%. Multivariate logistic regression analysis revealed that total prostate volume (odds ratio [OR]
= 1.067, 95% confidence interval [CI]: 1.023–1.113, P = .002) and intravesical prostatic protrusion (OR = 1.135,
95% CI: 1.056–1.219, P < .001) were independent risk factors for bladder diverticula in patients with benign prostatic
enlargement.
Conclusion: Bladder diverticula occurred in 6.77% of patients with benign prostatic enlargement in this cohort.
Total prostate volume and intravesical prostatic protrusion are independent risk factors for this complication and
may serve as clinical markers for risk evaluation.