Urology Journal

Purpose: Acute rejection (AR) of a kidney graft in renal transplant recipients is associated with microvascular injury leading to graft dysfunction and failure. Long noncoding RNAs (lncRNAs) may serve as markers for vascular injury and AR. We aimed to identify lncRNA biomarkers associated with graft loss after renal transplantation.

Materials and Methods: We searched PubMed, Scopus, Embase, and Web of Science. Odds ratios (ORs), hazard ratios (HRs), and their 95% confidence intervals (95% CIs) were calculated to assess effect sizes. All graphical designs and statistical analyses were performed using STATA version 17 (StataCorp LP, College Station, TX, USA) and the meta package.

Results: Of 291 initially identified articles, 10 met eligibility criteria and were included in the systematic review; 3 provided sufficient data for meta‑analysis. The pooled area under the curve (AUC) for lncRNA measurement in diagnosing acute kidney rejection was 0.79 in adults and 0.75 in pediatric populations, indicating good diagnostic accuracy. Leave‑one‑out sensitivity analyses confirmed the stability of these findings. However, the pooled HR for the prognostic value of lncRNAs was 0.81 (95% CI: 0.63–1.04), which was not statistically significant.

Conclusion: Assessment of lncRNA levels in plasma or urine appears promising as a diagnostic biomarker for acute kidney rejection. The prognostic value of lncRNAs in the course of acute kidney rejection requires further evaluation.

Purpose: Surgical management is a key component in treating adrenal masses, particularly when they are functional or large. However, the choice between partial adrenalectomy (PA) and total adrenalectomy (TA) remains controversial. Therefore, this systematic review and meta-analysis aimed to evaluate whether surgical outcomes differ between patients undergoing PA versus TA.

Materials and methods: Following PRISMA 2020 guidelines, we systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies published up to April 2025. Nineteen studies were included, and methodological quality was assessed using the Newcastle–Ottawa Scale (NOS). A random-effects meta-analysis was conducted to estimate pooled outcomes.

Results: A total of 19 studies comprising 3,165 patients were included, of whom 1,084 underwent partial adrenalectomy (PA) and 2,081 underwent total adrenalectomy (TA). PA was associated with a significantly higher risk of tumor recurrence compared with TA (RR = 2.64, 95% CI 1.55-4.51), while no significant differences were observed for metastasis or mortality. In contrast, PA significantly reduced the risk of postoperative steroid dependence (RR = 0.44, 95% CI 0.34-0.55) and adrenal insufficiency (RR = 0.49, 95% CI 0.34-0.70). Perioperative complications were less frequent following PA (RR = 0.56, 95% CI 0.40-0.78), particularly mild complications, with no differences in severe complications. There were no significant differences in operative time or intraoperative blood loss between the two techniques. Subgroup analyses demonstrated higher recurrence rates in pheochromocytoma among patients undergoing PA, compared with Conn’s adenoma. Perioperative complications were less frequent in PA in patients with Conn’s adenoma. No significant differences were observed regarding surgical laterality (left vs. right) or the operative approach (transperitoneal vs. retroperitoneal laparoscopic / robotic surgery).

Conclusion: PA offers superior preservation of adrenal function and fewer mild perioperative complications compared with TA, but shows a higher risk of tumor recurrence in pheochromocytoma patients. PA was not associated with higher recurrence in Conn’s patients. Other surgical and oncological outcomes were similar, underscoring the need to individualize the choice of procedure based on tumor type and patient factors.

Purpose: To investigate the safety and efficacy of supine percutaneous nephrolithotomy performed completely under ultrasound guidance without fluoroscopy and ureteral catheterization in kidneys with hydronephrosis.

Materials and Methods: This retrospective study analyzed the data of 30 patients (Group 1) with kidney stones larger than 2 cm and Grade 2 or higher hydronephrosis who underwent ultrasound-guided supine percutaneous nephrolithotomy without ureteral catheterization and fluoroscopy between January 2022 and November 2024. The data of these patients were compared using matched-pair analysis (1:1) with patients who underwent supine percutaneous nephrolithotomy under ultrasound and fluoroscopy guidance with ureteral catheterization (Group 2) in the same period. The groups were compared regarding access time, operation time, stone-free rates, blood loss, and complications.

Results: There were no statistically significant differences between the two groups in terms of age, gender, side, stone diameter, stone volume, stone density, hydronephrosis grade and Guy's stone score. Access time was significantly shorter in Group 1  (11.3 ± 3.9 minutes vs. 13.9 ± 4.7 minutes, respectively, 95% CI: 0.3-4.9, p = .026). The mean operation time was 64.4 ± 19.4 in Group 1 and 102.3 ± 31.2 in Group 2, and this difference was statistically significant (95% CI: 24.2-51.6, p = .001). There was no significant difference between the two groups in terms of postoperative 1st month stone-free rates (83.3% vs 86.6%, respectively, p = .723

Conclusion: Compared with standard supine mini percutaneous nephrolithotomy, totally ultrasound guided supine mini percutaneous nephrolithotomy without ureteral catheter is an effective, safe and feasible surgery.

Purpose: Urolithiasis is the condition of forming stones inside urinary tract with diverse shape, size, and location. The sooner urolithiasis is diagnosed, the easier it is to treat and prevent complication. This study aims to propose a method for predicting urolithiasis recurrence based on machine learning methods.

Materials and Methods: The proposed method uses clinical data, demographics, and CT findings of 4246 patients who were referred to the clinic once or multiple times within three years. The proposed method has three main phases of data engineering and pre-processing, machine learning prediction model development, and performance evaluation. In addition, the performance of six machine learning-based classifiers is evaluated by performance metric calculation, ROC curve analysis, calibration analysis, and decision curve analysis.

Results: The results of 10 independent repeats of the proposed method using a train/test split evaluation strategy reveal that the best-performing classifier is random forest with the area under the ROC curve, sensitivity, and positive predictive value of 0.64, 0.87, and 0.84, respectively. On the other hand, k-fold cross-validation: A comma is needed after "hand" and before "k-fold" evaluation strategy reveals that the best-performing classifier again is RF, with the area under the ROC curve, sensitivity, and positive predictive value of 0.63, 0.90, and 0.83, respectively. Moreover, the brier score of 0.18 shows that this classifier is well-calibrated among other evaluated classifiers.

Conclusion: This study presents a practical application of predictive machine learning methods for predicting urolithiasis recurrence with clinically acceptable accuracy compared to traditional scoring systems. To select the best classifier, six different predictive ML models have been evaluated using different performance metrics and analysis tools.

Purpose: Despite its prevalence, the etiology and pathogenesis of cryptorchidism remain poorly understood. This study aimed to identify potential biomarkers associated with cryptorchidism development using bioinformatics methodologies.

Materials and Methods: We utilized three microarray datasets from the Gene Expression Omnibus (GEO) database, comparing gene expression profiles between cryptorchidism patients and control individuals. Differentially expressed genes (DEGs) were identified using statistical analysis. Subsequently, we constructed a gene co-expression network using weighted gene co-expression network analysis (WGCNA) to identify modules of genes highly associated with the cryptorchid phenotype. Hub genes within these modules were identified using cross-validation and multiple algorithms.

Results: A total of 1,539 differentially expressed genes were identified between cryptorchidism patients and controls. WGCNA revealed a gene module strongly associated with the cryptorchidism phenotype. Ten genes (CDH1, CS, G6PD, HSPA5, KEAP1, NEDD8, POLR2J, JUN, SOD2, and TXN) with the highest association to cryptorchidism were identified in this module. Single‑gene gene set enrichment analysis (ssGSEA) showed that these hub genes were mainly enriched in metabolism-, translation-, and inflammation‑related processes. Notably, several key genes are involved in oxidative stress responses.

Conclusion: This study identified a credible set of hub genes associated with cryptorchidism. Some of these genes have been shown to affect testicular development or spermatogenesis through mechanisms such as inflammation and oxidative stress, while others have not been fully studied in the context of cryptorchidism. These hub genes may provide new biomarkers for cryptorchidism risk assessment and warrant further investigation to clarify their specific roles.

Purpose: Müllerian anomalies are rare, and the obstructed hemivagina and ipsilateral renal anomaly/agenesis (OHVIRA) syndrome is the rarest. Its subtle and nonspecific symptoms cause delays in diagnosis, especially in prepuberty. This study aims to remind this rare anomaly and review its symptoms, clinical and radiological findings, and treatment in pre- and post-pubertal girls.

Materials and Methods: We conducted a retrospective chart review of cases of OHVIRA syndrome that were diagnosed and treated between May 2018 and June 2024. We evaluated the results and reviewed relevant literature.

Results: Seven patients were diagnosed with OHVIRA syndrome during the study period. Two patients were diagnosed in the pre-pubertal period, and all post-pubertal cases, except one, underwent surgery. Five (71%) of the seven patients had left-sided obstructed hemivagina with ipsilateral renal agenesis.

Conclusion: OHVIRA syndrome is a rare condition. Its diagnosis and management depend on the patient’s age, symptoms, familiarity with the syndrome, and teamwork. Although a renal anomaly is part of the triad of this syndrome, OHVIRA syndrome often remains undiagnosed during infancy, even in cases of prenatally diagnosed renal agenesis. Screening for OHVIRA syndrome and associated urinary anomalies in cases of renal agenesis, particularly in prepubertal cases, is crucial.

Introduction: Open nephrectomy surgery in a kidney donor involves pain and many risks after the surgery, which leads to the inability to perform normal activities. For this reason, today the laparoscopic nephrectomy method is preferred in order to avoid complications and to return to normal life sooner. However, it is very critical to assess the impact of modifying the surgical technique on the outcome of kidney donation. Thus, the present study was undertaken with the following specific objective: a comparative study of the renal profile of live kidney donors who have undergone open and laparoscopic nephrectomy.

Materials and Methods: The study in the present report was cross-sectional in nature. Participants included 91 kidney donors who had undergone either open nephrectomy (n = 46) or laparoscopic nephrectomy (n = 45). Data on the level of initial basic renal function, the duration of surgery, and the duration of hospitalization, together with the course of renal function in the 6 months after surgery, were collected. The data were analyzed using the Statistical Package for the Social Sciences, version 27 (SPSS version 27).

Results: The mean age of kidney donors was 29.4 ± 4.8 years, and all patients were male (100%). Body mass index and weight were comparable between the open and laparoscopic nephrectomy groups, with no statistically significant differences (P > 0.05). The mean duration of surgery in the open nephrectomy group (2.37 ± 0.30 hours) was significantly shorter than that in the laparoscopic group (3.37 ± 0.13 hours) (P < 0.001). The mean length of hospital stay was significantly shorter in the laparoscopic group (3.31 ± 0.31 days) compared to the open group (4.06 ± 0.04 days) (P < 0.001). GFR decreased significantly in both groups at discharge and 6 months postoperatively compared to baseline (paired t-test, all P < 0.001), but there was no significant difference in GFR between groups at any time point (P > 0.05).  Both groups experienced a significant postoperative decline in hemoglobin, with a greater reduction in the open group (−1.59 ± 0.79 g/dL)  compared to the laparoscopic group (−1.05 ± 0.95 g/dL)  (P = 0.004). White blood cell counts increased postoperatively in both groups, with no significant difference between them (P = 0.118). Surgical complications included transection of the superior polar artery in 5.5% of cases.

Conclusion: In laparoscopic nephrectomy, the time of surgery is longer, but the days of hospitalization after surgery do not differ and do not negatively affect the return of donor kidney function compared to the open method. Moreover, post-surgical problems have not been very frequent and are manageable in the best way possible.