Medicine and Pharmacology

Abstract: Introduction: FGF23 and osteocalcin are important regulators of mineral and bone metabolism. The association between FGF23 and undercarboxylated osteocalcin (Glu-OC) in chronic kidney disease (CKD) remains insufficiently understood. This study aimed to investigate the association between FGF23 and Glu-OC and assess whether it is independent of kidney function. Methods: This cross-sectional study included 80 adults: 12 healthy controls and 68 patients with non-dialysis CKD stages G1–G4. FGF23, Glu-OC, calcium, phosphate, PTH, and bone metabolism markers were measured. Associations were assessed using Spearman correlation, partial Spearman correlation adjusted for eGFR, and multivariable linear regression. Results: FGF23 was inversely correlated with eGFR (ρ = −0.346; p = 0.004) and positively correlated with creatinine (ρ = 0.299; p = 0.013). FGF23 was inversely associated with Glu-OC (ρ = −0.344; p = 0.004), with the association becoming stronger after adjustment for eGFR (partial ρ = -0.477; p < 0.001). In complementary multivariable models, the inverse association between FGF23 and Glu-OC persisted: Glu-OC was associated with FGF23 (β = −0.258; p = 0.024), along with ALP (β = 0.369; p = 0.001), while FGF23 was associated with Glu-OC (β = −0.266; p = 0.020), along with calcium (β = −0.366; p = 0.002). Conclusion: FGF23 is independently and inversely associated with Glu-OC in non-dialysis CKD, and this relationship persists after adjustment for kidney function. These findings support an association between FGF23 and Glu-OC in CKD–mineral and bone disorder (CKD-MBD).

Abstract: In autosomal dominant polycystic kidney disease (ADPKD), arginine vasopressin (AVP) and copeptin, a marker of AVP secretion, play important roles. This study aimed to investigate the associations between coffee consumption, serum copeptin levels, and echocardiographic parameters in patients with ADPKD. The study included 75 patients with ADPKD. Serum copeptin levels were measured, monthly coffee consumption was recorded in g/month, and transthoracic echocardiography was performed. Copeptin levels were lower in coffee consumers (262.73 vs. 331.28 ng/L; p = 0.009) and were inversely correlated with coffee consumption status (r = −0.329; p = 0.008). After adjustment, the negative association between coffee consumption and copeptin levels remained significant (B = −0.284, β = −0.306; p = 0.030). Mitral annular e′ velocity was higher in coffee consumers (0.92 vs. 0.69 m/s; p = 0.029) and was significantly associated with coffee consumption after adjustment (B = 0.226, β = 0.263; p = 0.033). No significant associations were found with eGFR, left ventricular mass index, ejection fraction, or the E/e′ ratio. Coffee consumption was associated with lower copeptin levels and higher e′ velocity. These findings are hypothesis-generating and do not demonstrate causality, further comparative studies are needed to determine whether these associations are specific to ADPKD.

Abstract: Background/Objectives: Cryptorchidism occurs in numerous genetic developmental disorders, yet these associations are generally considered syndrome by syndrome, and the biological basis for their recurrence across molecularly heterogeneous conditions remains poorly understood. We aimed to characterize the clinical and molecular findings and develop a hypothesis-generating framework of developmental convergence. Methods: We retrospectively evaluated children with genetically confirmed rare developmental disorders who underwent surgical treatment for cryptorchidism at a tertiary pediatric urology center between 2015 and 2025. Clinical, operative, and molecular data were analyzed at patient and testis levels, and disorder-specific associations with cryptorchidism were evaluated through targeted literature review. Results: Among 94 children screened, 26 met the inclusion criteria, contributing 41 undescended testes. Cryptorchidism was bilateral in 57.7% of patients, 51.2% of testes were nonpalpable, and 51.2% were located at a high inguinal or intra-abdominal level. Despite substantial molecular heterogeneity, the underlying abnormalities could be organized into five interconnected developmental domains involving gene-expression regulation, signal sensing and integration, neural information transmission, neuromuscular execution and fetal mechanobiology, and mesenchymal and structural implementation. Conclusions: We propose that genetically distinct developmental disorders may perturb different levels of the biological system required for testicular descent while converging on shared downstream morphogenetic processes. This developmental-convergence model is hypothesis-generating and provides a testable framework linking human genetics, developmental biology, and pediatric urology.

Abstract: Background/Objectives: Salvage radical prostatectomy (SRP) is a potentially curative option for recurrent localized prostate cancer after primary radiation or focal therapy, historically limited by technical complexity and poor functional outcomes. Advances in robotic surgery have prompted re-evaluation of SRP. This study characterizes contem-porary perioperative, oncologic, and functional outcomes of salvage robotic-assisted radical prostatectomy (sRARP) at a single institution over two decades. Methods: We retrospectively reviewed patients undergoing SRP at our institution from 01/01/2004 to 06/30/2026, identified via combined institutional database query and natural language processing (NLP) keyword search with individual chart confirmation; analysis was re-stricted to the robotic-assisted subset. Clinicodemographic, perioperative, pathologic, and functional data were collected at diagnosis, recurrence, and following SRP, with conti-nence and erectile function also assessed at last follow-up. Descriptive statistics were reported as median (interquartile range, IQR) or n/N (%). Results: Of 4,002 records identified, 30 patients met inclusion criteria; 24 (80%) underwent sRARP. Extraprostatic disease was present in 54% (13/24) and positive margins in 43% (10/23). A postoperative complication occurred in 22% (4% Clavien-Dindo IIIa); bladder neck contracture devel-oped in 18% (4/22), and 8% (2/24) progressed to urinary diversion. At a median follow-up of 32.1 months, 70% (14/20) remained biochemically recurrence-free. Incontinence rose from 18% (3/17) at diagnosis to 83% (19/23) post-SRP; at longer-term follow-up (27.3 months), 79% (11/14) used ≥1 pad/day. Erectile dysfunction was present in 82% (14/17) at a median follow-up of 22.0 months. Additional cancer-control therapy, predominantly androgen deprivation therapy, was given in 33%. No deaths were attributed to an SRP-specific cause. Conclusions: In this study, sRARP achieved perioperative and high-grade complication rates comparable to the broader robotic salvage literature, with a 70% biochemical recurrence-free rate, supporting its role as a potentially curative option in selected patients. A substantial functional burden, particularly incontinence, and se-vere complications including urinary diversion underscore the need for refined patient selection, thorough counseling and further multi-institutional study.

Abstract: Background: Radical cystectomy (RC) with urinary diversion is considered the standard treatment for muscle-invasive and selected cases of high-risk non-muscle invasive bladder cancer. As a complex procedure it carries a high risk for complications, especially infectious ones. Orthotopic ileal neobladders (IN) have the highest risk of infectious complications and hospital readmission in comparison to ileal conduits. Unfortunately, the evidence for antibiotic management, including periprocedural prophylaxis and treatment of asymptomatic bacteriuria (ASB) in this special patient cohort is still limited. Furthermore, there is no international consensus on the clinical risk factors that justify intensified antibiotic use, leading to wide practice variability and concerns regarding antimicrobial stewardship. Objective: This Delphi consensus study aims to identify the best antibiotic management, including periprocedural prophylaxis as well as treatment of ASB, and define procedural, patient-related and microbiological risk factors that warrant antibiotic intensified usage in patients with RC and IN and to establish evidence-informed best practice recommendations. Methods: A modified three-round Delphi process will be conducted in accordance with DELPHISTAR guideline. A diverse panel of 30 – 40 international experts in urology, infectious diseases, microbiology, antimicrobial stewardship and medical oncologists will anonymously give recommendations for antibiotic management and evaluate predefined and newly suggested risk factors using a 6-point Likert scale. Consensus will be defined as ≥70% of participants rating an item as highly important (score 5–6) and <15% rating it as unimportant (score 1–2). Items failing to reach consensus in Rounds 1 and 2 will be reevaluated in subsequent rounds. Outcomes: The primary outcomes are consensus-based best practice recommendation for periprocedural antibiotic prophylaxis, antibiotic prophylaxis for catheter removal and definition of ASB as well as antibiotic management of ASB. The secondary outcome will be a consensus-based list of risk factors justifying intensified antibiotic usage in patients with RC and IN. Dissemination: Findings will be submitted for publication in peer-reviewed journals to support global efforts in harmonizing practice and promoting responsible antibiotic use in bladder cancer treatment with RC and IN.

Abstract: Background/Objectives: Sodium–glucose cotransporter 2 (SGLT2) inhibitors are established in chronic kidney disease, but evidence in glomerular disease is limited and patients on intensified immunosuppression have been excluded from the randomised trials. We examined the effect of dapagliflozin on proteinuria and kidney function over two years in such a population. Methods: Single-centre retrospective cohort study with historical controls. 147 patients treated with dapagliflozin between 2021 and 2025 were compared with 170 patients seen between 2014 and 2021, most with biopsy-proven glomerular diseases. Proteinuria and estimated glomerular filtration rate (eGFR) were assessed at months 0, 12 and 24, and comparisons used analysis of covariance adjusted for baseline. Subgroups on intensified immunosuppression at entry were prespecified. Results: Proteinuria fell by 51.9% under dapagliflozin and by 22.2% in the historical cohort; the adjusted geometric mean ratio (GMR) was 0.684 (95% CI 0.534–0.877; p = 0.003). During the second year the decline in eGFR was 4.61 mL/min/1.73 m² per year slower under dapagliflozin (95% CI 1.83–7.40; p = 0.001), and an eGFR below 15 mL/min/1.73 m² was reached by 0.7% of treated patients against 11.8% of controls. Among patients on intensified immunosuppression, proteinuria fell by 67.5% when dapagliflozin was added, against 4.6% on the same treatment without it (adjusted GMR 0.371; 95% CI 0.236–0.583; p < 0.001). Conclusions: Dapagliflozin was associated with a progressive antiproteinuric effect, most marked in patients on intensified immunosuppression, and with stabilisation of kidney function. Given the observational design, these magnitudes should be read as an upper bound.

Abstract: Background/Objectives: Letermovir is effective for cytomegalovirus (CMV) prophylaxis after kidney transplantation, but cytochrome P450 3A inhibition may alter tacrolimus and everolimus exposure. We evaluated changes in trough concentrations and dose requirements during letermovir initiation and discontinuation in de novo kidney transplant recipients. Methods: This single-center retrospective observational study included 20 living-donor kidney transplant recipients with D+/R− or R+ CMV serostatus receiving everolimus-based reduced-tacrolimus immunosuppression and letermovir prophylaxis. Trough concentrations, daily doses, kidney allograft function, CMV out-comes, and safety were assessed descriptively. Results: After letermovir initiation, mean tacrolimus trough concentrations increased by approximately 40–60% and evero-limus trough concentrations by approximately 35–50%, requiring dose reductions of approximately 45% and 30–40%, respectively. By day 7 after discontinuation, mean tacrolimus and everolimus trough concentrations decreased to 57.4% and 65.9% of baseline, respectively, while daily doses increased to 136.6% and 132.5%, respectively. Group mean serum creatinine and eGFR remained within approximately 10% of base-line. No CMV DNAemia or disease, leukopenia, neutropenia, acute T cell-mediated re-jection, or antibody-mediated rejection occurred; gastrointestinal symptoms occurred in three recipients. Conclusions: Letermovir was associated with rapid, reversible changes in tacrolimus and everolimus trough concentrations and dose requirements. Intensive therapeutic drug monitoring is warranted at both initiation and discontinuation.

Abstract: Background/Objectives: New data on the pathogenesis of recurrent urinary tract infections (RUTIs) and the growing level of bacterial resistance to antibiotics require a revision of patient treatment strategies and a search for non-antibiotic approaches to the treatment and prevention of UTIs. The aim of this study was to investigate the clinical and microbiological efficacy of a new, non-traditional antibacterial drug, Fluorothiazinone. Methods: We conducted an open-label, randomized, multicenter cohort clinical trial, phase IV, at 12 hospitals in Moscow and St. Petersburg. 280 patients were randomized into two groups in a 1:1 ratio to receive FT at a dose of 1200 mg/day for 14 days or furadonin at a dose of 400 mg/day. for 7 days. Clinical and microbiological cure were assessed 7, 14 and 28 days after the start of therapy. Results: For the primary efficacy endpoint, clinical cure at day 28, the recovery rate was 91.7% in patients receiving FT and 92.8% in patients receiving furadonin. The proportion of patients with clinical cure on days 7 and 14 also did not differ in the two groups and amounted to 69.6% and 85.3% of patients in the FT group, respectively, and 75.6% and 90.8% of patients in the furadonin group, respectively. An assessment of microbiological eradication at all observation times in our study (days 7, 14, and 28) convincingly demonstrated that FT, whose mechanism of action is associated with the suppression of pathogen virulence, possesses intrinsic antibacterial activity comparable to that of the antibiotic furadonin leading to the eradication of pathogens causing rUTIs. The frequency of microbiological relapses after 28 days of treatment was 20.0% in the group receiving FT and 22.8% in the group receiving furadonin. No statistically significant differences were found between the groups in the proportion of patients transferred to treatment other than that prescribed by the Protocol. Both study groups were comparable in the severity of AEs. A definite relationship with the study drugs was identified for 1 (11.1%) AE after taking FT and 8 (88.9%) AE after taking furadonin. Conclusions: Clinical trials in patients with recurrent cystitis have demonstrated the intrinsic antibacterial activity of FT, equal clinical and microbiological efficacy compared to first-line drugs for the treatment of recurrent cystitis, as well as a high level of safety, indicating the potential for the use of drugs with a new mechanism of action in the context of growing antibiotic resistance.

Abstract: Microscopic polyangiitis (MPA) is an autoimmune condition belonging to a group of vasculitides driven by interactions between anti-neutrophil cytoplasmic antibodies (ANCAs) and proteins within neutrophilic granules.1 Hydralazine, a direct-acting vasodilator, is a drug commonly used to treat hypertension, but is also known to induce a lupus like reaction, as well as AAV. Although life-threatening, there remains mysteries regarding hydralazine-induced microscopic polyangiitis, and investigation into these mysteries could prove lifesaving for patients. A total of 62 articles and books published from 1983 to 2026 were chosen through literature searches in PubMed, Science Direct, Embase, Elsevier, and Google scholar. Search terms were “hydralazine-induced microscopic polyangiitis” or “microscopic polyangiitis” as Mesh terms, and subsequent terms included “drug-induced vasculitides,” “glomerulonephritis,” and “diffuse alveolar hemorrhage.” Inclusion criteria included global studies focused on microscopic polyangiitis or drug induced vasculitides within the last fifty years, exclusion criteria studies older than fifty years. The most reliable diagnostic methods were proven to be a combination of ELISA and IIF for antibodies and histopathological evaluation after a detailed history from the patient. A consensus among the literature points to a combination therapy including corticosteroids and other immunosuppressants or biologics. However, detriments in the literature include demographic studies, mortality rates, and pathophysiology of the condition. Further research is needed to investigate epidemiology, exact pathophysiology, and mortality rates to develop treatment guidelines or prevent the disease altogether.

Abstract: Background/Objectives: Gross hematuria frequently requires continuous bladder irrigation (CBI), a measure that provides no pharmacological hemostatic effect. Intravesical tranexamic acid (TXA) and epinephrine have emerged as adjunctive agents to improve local bleeding control. This systematic review evaluates their efficacy and safety compared with conventional CBI. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science from inception to March 2025. Randomized controlled trials (RCTs) and non-randomized studies evaluating TXA and/or epinephrine versus CBI in urological gross hematuria were included. Risk of bias was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool and the Newcastle–Ottawa Scale (NOS). The protocol was prospectively registered in PROSPERO (CRD420251117904) and the review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Results: Seven studies (654 patients) were included: five RCTs and two non-randomized studies. Clinical contexts encompassed bleeding after transurethral resection of the prostate (TURP), spontaneous emergency department (ED) hematuria, and radiation cystitis. Intravesical TXA reduced CBI volume, ED length of stay, Foley catheter duration, and revisit rates. Intravenous TXA showed superior early hemoglobin preservation compared with the irrigation route in TURP patients. Intravesical epinephrine achieved hemostatic success in 86.7% of patients versus 46.7% with electrocautery fulguration (p < 0.001). No thromboembolic events were reported in any study. Conclusions: Intravesical TXA and epinephrine are efficacious and safe adjuncts for the management of gross hematuria, reducing resource utilization and improving clinical outcomes. Standardized dosing protocols and larger RCTs are needed.

Abstract: Background and Objectives: Older women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI) may remain dependent on pads or diapers despite clinically important symptoms. We described age-related care patterns and examined whether age remained associated with a predefined treatment gap after accounting for frailty and symptom burden. Materials and Methods: This single-center observational study combined record review (December 2023-April 2026) with a one-time questionnaire assessment (19 June-3 August 2026). The analysis included 480 women aged ≥65 years in three equal age groups (65-74, 75-84, and ≥85 years; n = 160 each). The treatment gap required an International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score ≥8, at least one pad or diaper per day, containment-only current management, and no active treatment during the preceding 12 months. Frailty and anxiety were assessed with the FRAIL scale and Geriatric Anxiety Inventory. Multivariable logistic regression examined factors associated with the treatment gap and a positive anxiety screen. Results: Treatment-gap prevalence was 33.8%, 44.4%, and 55.0% across increasing age groups. Supervised pelvic floor muscle training declined from 55.0% to 40.0% and 25.0%; active treatment in the preceding year from 50.0% to 35.0% and 20.0%; and previous continence surgery from 30.0% to 18.1% and 8.1%. After adjustment, age was not independently associated with the treatment gap. Higher symptom scores (adjusted odds ratio [aOR] 1.10 per point, 95% confidence interval [CI] 1.02-1.19) and stress-predominant MUI (aOR 1.53, 95% CI 1.03-2.25) remained associated. A positive anxiety screen was associated with symptom severity, MUI, nighttime containment, and social-activity limitation. Conclusions: Containment dependence increased and active-treatment exposure decreased with age; however, symptom burden and incontinence phenotype explained more of the adjusted treatment-gap risk than chronological age. Regular reassessment may help distinguish appropriate containment from potentially remediable under-treatment.

Abstract: Background: Simulation is a key clinical teaching tool in the context of uncommon but high-risk clinical contexts such as ischaemic priapism – a urological emergency. This initiative aims to develop a novel, low-cost priapism task-trainer as part of a priapism workshop to boost confidence and knowledge of urology resident doctors in the aetiology and management of priapism. Methods: A workshop comprising a 30-minute presentation on priapism aetiology and management, and 45-minute practical component, was delivered to a group of 6 urology resident doctors as part of the local departmental teaching programme. Consultant oversight in preparation and delivery of the session was used for content quality-assurance. The practical workshop component focussed on corporal aspiration utilising an innovative design of a priapism task-trainer with easily sourced and low-cost primary materials, short assembly time and acceptable fidelity with real-world clinical presentations. Results: Pre (N=5) /post (N=4) session responses showed increase in 10-point Likert scale median confidence scores in priapism aetiology (3 increased to 8) and management (2 to 8.5). Knowledge scores in aetiology and management were similar pre-post session (60% vs 63% average clinical scenario scores). Comments on the task-trainer showed participants valued the realism, accuracy, ease-of-use and interactivity that the task-trainer enabled. To improve, participants commented on longer time for practice. Discussion: This novel priapism workshop and corporal aspiration task-trainer represent a feasible, low-cost, realistic tool for boosting confidence of urology residents in priapism management, including corporal aspiration. Objective assessment of aspiration skills and knowledge scores should be considered in future larger-scale studies.

Abstract: Background and Objectives: Lower urinary tract symptoms (LUTS), such as urgency, frequency, and pelvic discomfort, are often attributed to bladder-centered mechanisms; nonetheless, several patients exhibit overlapping pelvic floor dysfunctions that existing urologic models do not fully explain. Evidence from the musculoskeletal and pain literature demonstrates that myofascial trigger points within the pelvic floor are prevalent in patients with pelvic pain and urinary symptoms, potentially contributing to symptom generation. In this narrative review, we synthesized the literature on pelvic floor myofascial dysfunction, referred pain patterns, and autonomic regulation of bladder function to develop an integrated neuromusculoskeletal framework. Materials and Methods: Relevant studies were identified through targeted database searches, AI-assisted literature screening, and manual reviews and selected based on mechanistic relevance. Results: The reviewed evidence supports a pathway in which active myofascial trigger points generate sustained nociceptive afferent inputs that converge with bladder afferents in the sacral spinal cord, potentially facilitating cross- and central sensitization, lowering the threshold for bladder sensation, and altering micturition reflex processing. The resulting amplification of afferent signaling provides a mechanistic basis for urgency, frequency, and pelvic pain in the absence of primary bladder pathology. Conclusions: This model integrates musculoskeletal and urological perspectives and suggests that in a subset of patients, LUTS may reflect the central processing of peripheral musculoskeletal input. Incorporating pelvic floor assessment into clinical evaluations may improve diagnostic accuracy and provide more targeted management. Further prospective studies are warranted to validate this integrated pathway and its therapeutic implications.

Abstract: Chronic kidney disease (CKD) now affects roughly 850 million people worldwide, and both its prevalence and its death toll are expected to keep climbing over the next few decades. We understand CKD’s underlying biology far better than we did a generation ago, yet the tools used to catch it early haven’t kept pace, and the drugs available to slow its progression remain only partly effective. Extracellular vesicles (EVs)- the nanoscale, membrane-bound particles that nearly every cell type sheds into its surroundings have stepped into this gap as candidates for both diagnosis and treatment. Pairing EV biology with artificial intelligence has given rise to what we call “Artificial Intelligence–Virtual Extracellular Vesicles” (AIVEVs): a computational approach that uses deep learning and multi-omics integration to design, predict, and fine-tune EV-based interventions for kidney disease. This review walks through where AIVEV technology stands today, covering AI-driven biomarker discovery in urinary and circulating EVs, computationally guided engineering of kidney-targeted therapeutic EVs, machine learning strategies for classifying EV subtypes, generative approaches to virtual EV design, physiologically based pharmacokinetic (PBPK) modeling for renal drug delivery, and the regulatory groundwork still needed before any of this reaches the clinic. As the global CKD burden grows and AI methods mature in parallel, AIVEVs look increasingly like a genuine shift in how nephrologists might one day diagnose, stage, and treat kidney disease.

Abstract: Background and Objectives: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has emerged as an alternative to the conventional anterior approach, aiming to preserve pelvic anatomical structures responsible for urinary continence while maintaining oncological safety. This study evaluated the perioperative, pathological, functional, and early oncological outcomes of RS-RARP in patients with clinically localized prostate cancer. Methods: This retrospective cohort study included 132 consecutive patients who underwent RS-RARP at a single institution. Demographic, perioperative, pathological, functional, and oncological data were retrospectively collected. Primary functional outcomes included postoperative urinary continence recovery, while pathological findings, positive surgical margins (PSMs), and postoperative prostate-specific antigen (PSA) levels were evaluated as oncological outcomes. Results: The median operative time was 170 min (IQR, 160–200), with a median estimated blood loss of 100 mL (IQR, 70–150). Blood transfusion was required in one patient (0.8%), and no Clavien–Dindo grade ≥III complications occurred. Pathological examination demonstrated ISUP Grade Group 2 disease in 64.9% of patients, while the overall PSM rate was 33.6%. The median time to both social continence (0–1 pad/day) and complete continence (0 pad/day) was 30 days. At final follow-up, 82.4% of patients achieved complete pad-free continence, 9.9% required one safety pad daily, and 6.9% required two or more pads. Median follow-up was 12 months. Postoperative PSA remained undetectable (<0.2 ng/mL) in all patients with available follow-up, and no patient required salvage therapy. Conclusions: RS-RARP is a safe and effective surgical approach associated with low perioperative morbidity, acceptable pathological outcomes, rapid urinary continence recovery, and encouraging short-term oncological control. These findings support the functional advantages of the Retzius-sparing technique without compromising early oncological outcomes; however, prospective multicenter studies with longer follow-up are needed to confirm long-term efficacy.

Abstract: Double-J ureteral stents are essential in modern urology but require timely removal or exchange. When retained beyond their intended indwelling period, forgotten stents can progress to severe encrustation, infection, and irreversible renal damage, and this burden falls disproportionately on low- and middle-income countries (LMICs), where fragmented follow-up systems, financial barriers, and limited access to advanced endourological care compound risk. This narrative review critically examines the epidemiology, risk factors, complications, classification systems, imaging evaluation, and management of forgotten double-J stents, with particular emphasis on prevention strategies feasible in LMIC settings, and proposes a structured prevention framework. Reported incidence of forgotten stents ranges from under 1% to over 12%, with prolonged dwell time the strongest predictor of encrustation. Management requires individualized, distal-to-proximal endourological strategies, frequently involving multiple modalities or staged procedures in high-grade disease. Prevention is most effective when treated as an institutional responsibility rather than a matter of patient compliance: structured registries, multichannel reminder systems, and low-cost digital tools such as SMS-based tracking and smartphone registries have demonstrated substantial reductions in forgotten-stent rates, including in LMIC settings. Artificial intelligence shows early promise for follow-up risk prediction and encrustation grading but requires further external validation before clinical adoption. Forgotten double-J stents are a largely preventable patient-safety event rather than a failure of patient compliance alone. We propose the STENT-SAFE framework — Scrutinize the indication, Time-stamp removal, Educate using teach-back, Notify through multiple channels, Track every stent centrally, Safety-net high-risk patients, Act on overdue cases, Finalize only after verification, and Evaluate and audit — as a practical, resource-adaptable model for institutions across the LMIC resource spectrum.

Abstract: Mechanical ventilation may induce extrapulmonary responses shaped by the host inflammatory-metabolic background. This exploratory study characterized renal functional changes during 1 h of reduced-tidal-volume mechanical ventilation in male Wistar rats with diet-induced obesity or lipopolysaccharide (LPS)-induced endotoxemia, together with concurrent respiratory, acid–base, metabolic, and hemodynamic alterations. Arterial blood gas, biochemical, hemodynamic, and urinary variables were assessed at the pre-MV and post-MV time points. Renal protein expression was evaluated only at the post-MV time point. The arterial partial pressure of carbon dioxide (PaCO₂) decreased significantly in both groups. In the Obese group, metabolic acid–base abnormalities persisted and were accompanied by increases in serum urea and the urinary protein-to-creatinine ratio. In the LPS group, lactate increased, bicarbonate decreased, and mean arterial pressure and serum creatinine increased. At the post-MV time point, renal interleukin-6 expression was higher in the Obese group than in the LPS group, whereas renal tumor necrosis factor-alpha expression was higher in the LPS group than in the Obese group. These findings indicate that a shared reduction in PaCO₂ may coexist with phenotype-associated renal and systemic patterns. The results support the interpretation that physiological and renal changes observed during mechanical ventilation should be considered in relation to the underlying pathophysiology and inflammatory-metabolic context of the host.

Abstract: Urinary continence in healthy women is not a strictly two-body elastic collision but a viscoelastic process of energy storage and release involving neuromuscular regulation, pelvic floor soft-tissue response, and fascial and ligamentous constraint. During surges in intra-abdominal pressure, the pelvic floor muscles contract in anticipation, the soft tissues deform reversibly, and elastic potential energy is transiently stored, while the pelvic support system supplies the structural constraint required for functional closure of the urethra and bladder neck; once the pressure subsides, the stored energy restores a configuration closely resembling the initial state. Building on this analogy, we propose three sequential principles for physiological reconstruction: (1) reconstructing the perineal body and the levator hiatus plane to restore a stable fulcrum; (2) reconstructing functional closure of the bladder neck and proximal urethra under appropriate indications, while minimizing abnormal tension and the tendency to gape; and (3) restoring continence to a structural–functional state governed primarily by autologous tissue, supplemented by limited synthetic material when necessary. In stress urinary incontinence with moderate-to-severe cystocele, native support is often extensively damaged and autologous repair alone may carry a long-term recurrence risk; judicious synthetic reinforcement after careful evaluation of indications, material risks and patient benefit is therefore a reasonable option. Preliminary clinical experience suggests improved total continence without compromising voiding safety; standardized trials are required.

Abstract: The maintenance of calcium and phosphate homeostasis is governed by a highly regulated and complex hormonal network involving parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and activated vitamin D (calcitriol). As kidney function declines, the capacity to excrete phosphate and absorb calcium both diminish, resulting in progressive disturbances in bone and mineral metabolism. This disruption promotes an imbalance in calcium–phosphate homeostasis that favors dissolution of bone with simultaneous deposition of calcium–phosphate complexes in soft tissues and the vasculature. Clinically, these derangements manifest as a broad and heterogeneous spectrum of disease, including bone pathology, vascular and valvular calcification, tumoral calcinosis, and calciphylaxis. Notably, these markedly different clinical phenotypes can present in patients with advanced chronic kidney disease (CKD) and End Stage Kidney Disease (ESKD) who exhibit seemingly similar biochemical and hormonal profiles. The determinants of this tissue-specific susceptibility remain incompletely understood and likely reflect a complex interplay between local tissue biology, systemic regulators of mineral metabolism, and environmental influences. This review will systematically present the diverse manifestations of calcium–phosphate imbalance in advanced CKD and explore the underlying pathophysiologic mechanisms that may determine why certain patients develop specific complications while others do not.

Abstract: Micro- and nanoplastics (MNPs) are reported in blood, urine, and tissues, including the kidney, raising concern that the urinary system may be both a target and a route of elimination. This narrative review integrates analytical, toxicokinetic, experimental, epidemiological, and dialysis-related evidence on MNPs and renal health. Human studies demonstrate renal access and urinary detection, but estimates are strongly method-dependent and do not yet define tissue dose, clearance, or a disease threshold. Cell, kidney-organoid, and animal studies consistently identify oxidative and mitochondrial stress, endoplasmic-reticulum dysfunction, inflammation, altered autophagy, regulated cell death, senescence, and fibrotic remodelling. Effects vary with polymer, size, shape, surface ageing, route, dose, and chemical co-exposures, and many experiments remain difficult to map to typical human exposure. Direct human outcome evidence is limited to cross-sectional or exploratory studies; plasticizer epidemiology is informative for chemical co-exposure but cannot establish particle-specific toxicity. Patients with chronic kidney disease may be more susceptible, while kidney dysfunction may also alter measured blood or urinary concentrations. Dialysis introduces an additional, incompletely quantified exposure system. MNP-related renal injury is biologically plausible, but causal contribution to human kidney disease and clinical actionability remain unproven. Standardized methods, paired-matrix kinetics, prospective cohorts, and complete dialysis mass-balance studies are priorities.