Medicine and Pharmacology

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.

Abstract: Introduction: Pediatric uroflowmetry is volume dependent, and low-volume voids can yield recordings that require repetition or cannot be interpreted confidently. Objective: To evaluate the association between documented bladder scan-guided test timing and first-attempt uroflowmetry adequacy in children. Study design: This single-center retrospective workflow cohort included 110 toilet-trained children aged 5-12 years who underwent uroflowmetry for suspected non-neurogenic lower urinary tract dysfunction. The exposure was defined from contemporaneous pre-test documentation as bladder scan-guided timing (n=55) or standard urge-based timing (n=55). Expected bladder capacity (EBC) was calculated as (age + 1) × 30 mL. The primary outcome was first-attempt voided volume ≥50% EBC. Key secondary outcomes were repetition because of inadequate volume and workflow time. Analyses were observational and effect estimates were interpreted as associations. Results: Adequate first-attempt voided volume was documented in 50/55 children (90.9%) in the scan-guided cohort and 39/55 (70.9%) in the standard cohort (unadjusted risk ratio 1.28, 95% confidence interval [CI] 1.06-1.55; risk difference 20.0 percentage points, 95% CI 5.8-34.2). Repetition because of inadequate volume, the direct workflow consequence of primary-outcome failure, occurred in 9.1% versus 29.1%. Scan-guided timing was also associated with a higher voided volume/EBC ratio (mean difference 15.1 percentage points, 95% CI 7.2-23.0), shorter total completion time (-8.8 min, 95% CI -14.9 to -2.7), and shorter documented active staff time (-3.8 min, 95% CI -5.6 to -2.0). Discussion: Objective bladder-volume information was associated with greater first-attempt volume adequacy and shorter workflow times. However, the retrospective exposure definition, uncertain workflow-selection mechanism, unadjusted primary analysis, and reliance on routine documentation prevent causal interpretation. Conclusion: Documented bladder scan-guided timing was associated with greater first-attempt pediatric uroflowmetry adequacy than standard urge-based preparation. The findings should be considered hypothesis-generating pending adjusted patient-level analyses and prospective validation.

Abstract: Traumatic injury remains a critical global health challenge, with polytrauma frequently leading to multi-organ failure and mortality. A severe complication of polytrauma is acute kidney injury (AKI), which is driven by a massive systemic inflammatory response following the initial insult. This inflammation is exacerbated by the upregulation of phosphodiesterase 4 (PDE4) enzymes; therefore, PDE4 inhibition represents a rational therapeutic strategy. Roflumilast is an FDA-approved PDE4 inhibitor currently used for chronic obstructive pulmonary disease (COPD). This study evaluated the hypothesis that roflumilast can mitigate inflammation and prevent AKI in a polytrauma rat model. Anesthetized male Sprague-Dawley rats were randomly assigned to either a vehicle control group (n=9) or a roflumilast treatment group (0.2 mg/kg, n=10). All animals underwent a polytrauma protocol—including soft tissue injury, fibula fracture, and pressure-controlled hemorrhage—followed by whole blood resuscitation and a 72-hour observation period. Rats treated with roflumilast demonstrated higher survival rates compared to injury controls (70% vs. 33%). Furthermore, roflumilast treatment significantly lowered blood urea nitrogen (BUN, p< 0.05) and renal levels of Kidney Injury Molecule-1 (KIM-1, p< 0.05). Roflumilast also significantly reduced levels of circulating High Mobility Group Box 1 (HMGB1) (p< 0.05) and the proinflammatory cytokine Macrophage Inflammatory Protein-1 alpha (MIP-1α) (p< 0.05). These findings suggest that roflumilast is a promising therapeutic agent for mitigating trauma-induced AKI by attenuating systemic inflammatory response.

Abstract: Chronic kidney disease (CKD) represents a major global health challenge, affecting more than 10% of the population and contributing substantially to morbidity and premature mortality. Growing evidence identifies oxidative stress and mitochondrial dysfunction as central drivers of renal injury and disease progression across diverse etiologies. The kidney is one of the most mitochondria-rich organs in the body, reflecting the high bioenergetic demands required for tubular reabsorption and metabolic homeostasis. Disruption of mitochondrial oxidative phosphorylation, excessive production of reactive oxygen species (ROS), and impaired mitochondrial quality control mechanisms promote tubular injury, inflammation, and fibrosis. In particular, dysfunction of the electron transport chain, activation of NADPH oxidase isoforms—especially NOX4—and alterations in mitochondrial dynamics create a vicious cycle of oxidative damage and bioenergetic failure. Emerging evidence highlights the importance of mitochondrial quality control pathways, including fusion–fission balance, PINK1/Parkin-mediated mitophagy, and mitochondrial biogenesis regulated by PGC-1α and TFAM. Recent studies have also identified additional mechanisms linking mitochondrial dysfunction to CKD progression, including ferroptosis, epigenetic regulation of mitochondrial genes, and mitochondrial DNA release acting as damage-associated molecular patterns that activate innate immune pathways. At the clinical level, redox and mitochondrial biomarkers—such as F2-isoprostanes, 8-hydroxy-2′-deoxyguanosine, advanced oxidation protein products, and circulating mitochondrial DNA—may improve early diagnosis and risk stratification. Therapeutically, both established nephroprotective drugs and emerging mitochondria-targeted interventions aim to restore mitochondrial homeostasis and represent promising strategies for slowing CKD progression.

Abstract: Background: The ERSPC-MRI PM is of the most widely used and extensively validated predictive model in Europe. Objective: We aimed to validate and compare the perfor-mance of the BCN-MRI PM and ERSPC-MRI PM in an Ibero-American population. Met-hods: We conducted a prospective analysis of 540 men with suspected PCa who underwent MRI and prostate biopsy in 2025. Individual csPCa risk estimates were cal-culated using the online calculators for the BCN-MRI PM and ERSPC-MRI PM. Results: The overall csPCa detection rate was 55.7%. The BCN-MRI PM demonstrated good cali-bration, with close agreement between predicted and observed csPCa probabilities, whereas the ERSPC-MRI PM underestimated risk in the intermediate-probability range. Discrimination for csPCa was significantly better with the BCN-MRI PM (AUC, 0.807; 95% CI 0.771-0.843) than with the ERSPC-MRI PM (AUC, 0.764; 95% CI 0.724-0.803; p < 0,001). Decision curve analysis showed a greater net benefit for the BCN-MRI PM than for the ERSPC-MRI PM and the strategy of biopsying all men. Clinical utility curves demon-strated a more favorable balance between avoided biopsies and missed csPCa cases across threshold probabilities. At a sensitivity of 95%, the BCN-MRI PM achieved a specificity of 38.9% (95% CI, 32.5%–45.1%) compared with 30.1% (95% CI, 24.6%–35.7%) for the ERSPC-MRI PM, avoiding 21.5% and 16.3% of biopsies, respectively (p = 0.043). The performance of both models was also evaluated according to PI-RADS category and participating center. Conclusions: In this Ibero-American cohort, the BCN-MRI PM demonstrated superior calibration and overall clinical performance compared with the ERSPC-MRI PM.

Abstract: Three-dimensional (3D) ultrasound may complement conventional scrotal imaging by displaying the testis and epididymis within a single reconstructed volume. We present a volume-rendered 3D ultrasound image obtained during the infertility evaluation of an adult male. Scrotal imaging was performed using a Samsung Medison ultrasound system with an LV3-14A linear transducer. Following standard two-dimensional assessment, a volumetric dataset was acquired and reconstructed using multiplanar and volume-rendering modes. The image demonstrated an apparently small ovoid testis with a disproportionately prominent, elongated epididymis along its posterior aspect. This appearance provided an intuitive representation of the size discordance and anatomical relationship between the two structures. However, the finding is descriptive rather than diagnostic because quantitative measurements and Doppler information were not available. Interpretation should therefore be correlated with grayscale and color Doppler imaging, clinical history, semen analysis, and hormonal evaluation. Further studies are needed to determine whether quantitative 3D measurements improve male infertility assessment.

Abstract: Background: Grade 1 vesicoureteral reflux (VUR) is generally considered a low-risk condition and is commonly grouped with other low-grade reflux categories in the literature. Consequently, long-term outcome data specifically addressing Grade 1 VUR remains limited. We evaluated the long-term renal and infectious outcomes of children with Grade 1 VUR and characterized their principal associated clinical phenotypes. Methods: This retrospective cohort study included children diagnosed with Grade 1 VUR between 2008 and 2025 at a tertiary pediatric urology center. Primary outcomes were breakthrough urinary tract infection (UTI), proteinuria, and new renal scar formation. Principal associated clinical phenotypes and factors associated with adverse outcomes were evaluated using univariable analyses. Results: A total of 132 children with Grade 1 VUR involving 154 refluxing renal units were included. Median age at diagnosis was 6 years (IQR 4–9.25), and median follow-up was 8 years (IQR 5–9). A principal associated clinical phenotype was identified in all patients, most commonly voiding dysfunction (38.6%), recurrent UTI (28.0%), and renal anomaly (25.0%). Breakthrough UTI occurred in 46 patients (34.8%), proteinuria in 6 (4.5%), and new renal scar formation in 7 (5.3%). Renal adverse outcomes (proteinuria and/or new scar formation) developed in 10 patients (7.6%). Older age at diagnosis (p<0.001) and abnormal baseline DMSA findings (80.0% vs. 41.8%, p=0.040) were associated with renal adverse outcomes, while female sex was associated with breakthrough UTI (p=0.009). Conclusions: In this tertiary referral cohort, clinically relevant infectious and renal outcomes occurred despite low-grade reflux. Grade 1 VUR should not be assumed benign when accompanied by recurrent infection, urinary tract dysfunction, renal anomalies, or abnormal baseline DMSA findings. These findings support a phenotype-based approach to risk assessment rather than reliance on reflux grade alone.

Abstract: Background: Endothelial dysfunction plays a central role in the pathophysiology of erectile dysfunction (ED) and reflects systemic vascular impairment. Photoplethysmography-derived flow-mediated dilation (PPG-FMD) has emerged as a novel, non-invasive approach for assessing endothelial function. This study aimed to investigate the utility of PPG-FMD as a marker of systemic endothelial function in patients with ED without overt coronary artery disease. Methods: In this observational cross-sectional comparative study, patients with vascular ED (n = 24), non-vascular ED (n = 18), and healthy controls (n = 30) were evaluated. Endothelial function was assessed using PPG-FMD. Key parameters, including dilation index, time to maximum dilation, area under the curve, and dilation index slope, were analyzed and compared across groups. Results: PPG-FMD parameters indicated significantly impaired endothelial function in patients with vascular ED compared to both non-vascular ED patients and controls (p < 0.001). Dilation index and area under the curve were significantly reduced in the vascular ED group. Conclusions: These findings support the presence of systemic endothelial dysfunction in vascular ED and suggest that PPG-FMD–derived parameters may serve as a non-invasive indicator of endothelial function. Further studies incorporating larger cohorts and validation against established endothelial assessment methods are required to determine its clinical applicability.

Abstract: Introduction: Accurate preoperative characterization of renal tumor anatomy is essential for partial nephrectomy. Although the R.E.N.A.L. nephrometry score is widely used to assess tumor complexity, its interpretation using conventional computed tomography (CT) may vary among observers. We evaluated whether three-dimensional (3D) reconstruction improves the consistency of preoperative R.E.N.A.L. score assessment. As a secondary objective, perioperative outcomes were compared between patients planned with CT plus 3D reconstruction and those planned with CT alone. Materials and Methods: A retrospective observational study included 55 patients who underwent partial nephrectomy between March 2023 and March 2025. Three experienced urologists independently assigned R.E.N.A.L. nephrometry scores using conventional CT and CT-based 3D reconstructions. Interobserver and intraobserver agreement were assessed using Pearson correlation coefficients, weighted Cohen's kappa, and Fleiss' kappa. Perioperative outcomes were analyzed in a comparable control cohort planned using CT alone. Results: Three-dimensional reconstruction demonstrated greater interobserver agreement than CT alone for both numerical R.E.N.A.L. scores (57% vs. 43%) and risk categorization (72% vs. 62%). Fleiss' kappa indicated very good agreement with 3D reconstruction (κ=0.804) compared with moderate agreement using CT (κ=0.562). Intraobserver agreement between CT and 3D reconstruction was moderate. No significant differences were observed in operative time, warm ischemia time, blood loss, postoperative renal function, or complication rates. Hospital stay was slightly longer in the 3D group. Conclusions: Three-dimensional reconstruction may represent a valuable complementary tool for improving the consistency of preoperative R.E.N.A.L. nephrometry score assessment. Although greater agreement did not translate into measurable perioperative benefits in this cohort, more reproducible anatomical characterization may contribute to a more standardized framework for surgical planning before partial nephrectomy.

Abstract:

Background: Urinary incontinence (UI) is very common, affecting 421 million women and men worldwide. There are three types of UI: stress, urge and mixed. UI is associated with poor quality of life. There are numerous non-surgical treatments available. This paper reviews the mechanisms and clinical evidence for mechanotherapy gleaned from peer-reviewed literature. Mechanisms: The human body responds to various forms mechanical stimuli that direct cellular tissue forces, resulting in molecular responses that facilitate growth, remodeling and repair. Mechanotransduction is the basis for mechanotherapy, characterized by complex chemical signaling and neural signaling. Two modalities of mechanotherapy have been investigated in published studies. Mechanical Vibration: Vibration caused by oscillatory motion stimulates stretch sensitive mechanoreceptors in the pelvic floor muscle (PFM) spindles, resulting in afferent nerve impulses to the sacral plexus and centers in the brain. Resulting efferent signals cause motor unit activation. Types of vibration delivery include intra-vaginal, whole-body, and local transcutaneous. Acoustical Wave Stimulation: Acoustic energy generated by piezoelectric crystals modify molecules as the waves are transmitted from one molecule to another. This type of mechanotherapy includes four stages: propagation, physical effect, mechanotransduction and biological effect. Most published research studies utilized low intensity extracorporeal shock waves (LiESWT) in their protocols. Conclusion: Mechanotherapy provides powerful physiologic stimulation that has been shown in many studies to improve clinical symptoms of UI and improve QoL. It is a promising, emerging, non-invasive option for inclusion in the clinical armamentarium for treating patients with all forms of UI.

Abstract: Urothelial carcinoma of the bladder remains challenging to assess in real time. Standard tools such as white-light cystoscopy and urine cytology are essential but have recognized limitations, particularly for carcinoma in situ and for repeated, long-term surveillance in non-muscle-invasive bladder cancer (NMIBC). Conventional risk models also show imperfect performance in contemporary practice, contributing to both overtreatment and delayed escalation in biologically aggressive disease. Long non-coding RNAs (lncRNAs) are emerging as attractive biomarkers because of their context-specific expression and their detectability in urine, including within extracellular vesicles/exosomes that protect RNA from degradation. Urinary lncRNAs show promise as non-invasive tools for hematuria triage and diagnostic support, risk stratification for recurrence and progression, and treatment guidance in selected settings. Repeatedly studied candidates include UCA1 and several exosomal/uEV-associated lncRNAs (e.g., TERC, SNHG16), while multi-lncRNA panels and combined strategies (including integration with established urine tests such as NMP22) may stabilize performance across biological and pre-analytical variability. Evidence also supports the concept of longitudinal “molecular response” monitoring using liquid-based lncRNA readouts, although truly predictive, treatment-interaction evidence remains limited. Across studies, performance is strongly influenced by the urine compartment analyzed (pellet/sediment, cell-free urine, or uEVs/exosomes) and by pre-analytical handling and normalization choices. lncRNA assays are unlikely to replace cystoscopy in the near term, but they have clear potential as decision-support tests that complement clinical risk assessment, cytology, and other urine-based platforms. This work synthesizes mechanistic and clinically annotated evidence on lncRNAs in bladder cancer, with an emphasis on urine-based and urinary extracellular vesicle (uEV)/exosomal assays. The search strategy covered publications from 1 January 2015 to 30 December 2025, with emphasis on most recent clinically relevant studies, and included mechanistic studies with functional validation, liquid biopsy/urine studies, and evidence syntheses.

Abstract: Subarachnoid hemorrhage (SAH) induces a sympathetic surge and systemic inflammation that may impair renal perfusion and glomerular integrity. Although the vagus nerve is central to autonomic and anti-inflammatory regulation, its relationship to renal structural injury in severe SAH is unclear. This study evaluated whether electrophysiological vagal CAP amplitude correlates with glomerular integrity in an experimental SAH model. Nineteen rabbits were assigned to control (n = 5), sham (n = 5), and SAH groups (n = 9). SAH was induced by daily cisterna magna injections of autologous blood for three days, and animals were followed for 14 days; those that did not survive to the 14-day endpoint formed the SAH-Nonsurvivor subgroup (n = 4). Vagal compound action potential (CAP) amplitude (mV) was recorded electrophysiologically and used as the principal physiologic readout of vagal nerve integrity. Renal tissue and perirenal parasympathetic ganglia were analyzed histologically and stereologically to quantify degenerated neurons and atrophic glomeruli (per mm³). Vagal CAP amplitude decreased from 1.42 ± 0.36 mV in controls to 0.34 ± 0.11 mV in the SAH-Nonsurvivor subgroup (p < 0.001), while atrophic glomeruli increased from 4 ± 1 to 98 ± 11 per mm³. Degenerated neuronal density peaked in the SAH-Nonsurvivor subgroup (98 ± 19 per mm³). Vagal CAP amplitude was inversely correlated with glomerular injury (Spearman ρ = –0.89, p < 0.001). In this small exploratory study, reduced vagal CAP amplitude was associated with greater glomerular injury after severe SAH. These hypothesis-generating findings warrant confirmation in larger, adequately powered studies before any physiologic or translational interpretation can be made.

Abstract: Introduction: The optimal surgical approach for elderly bladder cancer patients remains controversial. We compared perioperative morbidity and short-term outcomes in patients aged ≥75 years undergoing open radical cystectomy (ORC) versus robotic-assisted radical cystectomy (RARC). Methods: A retrospective, multicenter cohort study was performed including 179 patients aged ≥75 years, of whom 101 underwent RARC between 2021 and 2025, and 78 underwent ORC between 2016 and 2020. After 1:1 propensity score matching, 138 patients were analyzed to assess perioperative complications and oncological outcomes, adjusting for age, body mass index (BMI), pathological stage, comorbidities, prior chemotherapy, and type of urinary diversion. Perioperative complications and oncological outcomes were subsequently compared between the two groups. Results: Following propensity score matching, RARC was associated with longer operative time (332 vs. 247 min; p< 0.001) but resulted in significantly lower blood loss (310 vs. 743 mL; p< 0.001), reduced transfusion rates, shorter length of hospital stay (p< 0.001), and fewer overall intraoperative complications (8.7% vs. 18.8%; p=0.04). Patients undergoing RARC also experienced lower rates of any complications (43.4% vs. 62.3%; p=0.02), major complications (Clavien–Dindo III–V: 11.6% vs. 27.5%; p=0.03), and postoperative mortality (1.4% vs. 2.9%; p< 0.001) compared with ORC. In multivariate analysis, surgical approach independently predicted major complications, with RARC conferring a significantly lower risk (OR 0.75; 95% CI 0.51–0.88; p=0.04). Analysis of the learning curve showed a significant reduction in major complications over time for RARC (OR 0.68; 95% CI 0.53–0.93; p=0.01) but not for ORC. Conclusion: RARC offers superior perioperative outcomes, including reduced blood loss, shorter hospitalization, and lower rates of major complications, without compromising oncological control. These data support RARC as a safe and effective option for elderly patients undergoing radical cystectomy.