Objective:To explore the influencing factors for pathological upgrading in prostate cancer patients with a Gleason score of 3 + 3 undergoing targeted biopsy，and to establish a nomogram prediction model.Methods:A retrospective analysis was conducted on 191 patients with localized prostate cancer diagnosed with a Gleason score of 3 + 3 through targeted biopsies at the First Affiliated Hospital of Nanjing Medical University from January 2020 to June 2024. The age of the patients was 67（61，73）years，with prostate-specific antigen（PSA）level of 7.44（5.53，10.19）ng/ml，prostate volume of 35.64（26.59，48.97）ml，and PSA density（PSAD）of 0.20（0.14，0.31）ng/ml 2. Among them，61 cases（31.94%）had a Prostate Imaging Reporting and Data System（PI-RADS）score of 3，104 cases（54.45%）had a score of 4，and 26 cases（13.61%）had a score of 5. The diameter of the main lesion was 10.75（7.86，14.00）mm. The lesions were located in the peripheral zone in 78 cases（40.84%），the transition zone in 99 cases（51.83%），and the anterior fibromuscular stroma in 14 cases（7.33%）. The lesions were found at the apex in 56 cases（29.32%），in the body in 120 cases（62.83%），and at the base in 15 cases（7.85%）. MRI revealed only one lesion with a PI-RADS score ≥ 3 in 131 cases，two suspected lesions in 43 cases，three suspected lesions in 12 cases，and four suspected lesions in 5 cases. Systematic biopsy was positive in 121 cases（63.4%）and negative in 70 cases（36.6%）. The lesions were confined to the left lobe in 63 cases（32.98%），right lobe in 68 cases（35.60%），and involved both lobes in 60 cases（31.41%）. The interval between biopsy and surgery was 9.0（7.0，14.0）days. Univariate analyses were performed using Mann-Whitney U tests or χ2 tests，and multivariate logistic regression was used to identify independent predictors of pathological upgrading. A nomogram model was constructed based on these independent predictors. The model’s discriminative ability was assessed using the area under the receiver operating characteristic（ROC）curve（AUC），and internal validation of the model’s consistency was conducted using the bootstrap resampling method. Decision curve analysis（DCA）was performed to assess clinical utility. Results:Among the 191 cases，60（31.4%）had no pathological upgrading after surgery，while 131（68.6%）showed upgrading. Univariate analysis showed that the maximum diameter of the main lesion［9.0（6.0，13.2）mm vs. 11.0（8.4，14.0）mm］，number of suspicious lesions on MRI［1.0（1.0，1.0）vs. 1.0（1.0，2.0）］，number of positive systematic biopsy cores［1.0（0，2.0）vs. 1.0（0，3.0）］，percentage of positive systematic biopsy cores［0.08（0，0.17）vs. 0.12（0，0.25）］，number of positive targeted biopsy cores［2.0（1.0，3.0）vs. 3.0（1.0，4.0）］，percentage of positive targeted biopsy cores［0.37（0.24，0.75）vs. 0.50（0.38，0.85）］，level of the index lesion，location of the index lesion，and PI-RADS score were associated with pathological upgrading（ P < 0.05）. Multivariate logistic regression analysis showed that PI-RADS score 4（ OR = 5.88，95% CI 2.41 - 14.35），number of suspicious lesions on MRI（ OR = 4.15，95% CI 1.88 - 9.17），location of the index lesion in the transition zone（ OR = 6.86，95% CI 2.81 - 16.73），and percentage of positive targeted biopsy cores（ OR = 4.37，95% CI 1.38 - 14.90）were independent risk factors for pathological upgrading（ P < 0.05）. The nomogram model constructed using these predictors had an AUC of 0.845. Internal validation using the Bootstrap method yielded an AUC value of 0.812，indicating high predictive accuracy of the model. The calibration curve indicated good calibration. Decision curve analysis showed that the threshold range for net benefit in the model was between 12% - 100%. Conclusions:The PI-RADS score 4，the number of lesions with PI-RADS ≥ 3，the location of the main lesion in the transition zone，and the percentage of positive needles in targeted biopsy are independent risk factors for pathological upgrading from Gleason score 3 + 3. The nomogram model constructed from these factors demonstrates good predictive performance and provides a reference for clinical decision-making.

Objective:To compare the burden of benign prostatic hyperplasia（BPH）between China and the United States from 1990 to 2021.Methods:The prevalence，incidence，years lived with disability（YLD），and their age-standardized rates for BPH in China and the United States from 1990 to 2021 were obtained from the Global Burden of Disease Study 2021（GBD 2021）. The average annual percentage change（AAPC）of the age-standardized incidence rate（ASIR）and the age-standardized YLD rate（ASYR）was calculated using Joinpoint regression analysis. In addition，the YLD burden of BPH，prostate cancer，kidney cancer，bladder cancer，and three other urological diseases were compared between the two countries.Results:From 1990 to 2021，the number of BPH cases in China increased from 1.460 4 million to 3.244 5 million，the number of prevalent cases rose from 9.940 5 million to 23.111 2 million，and YLDs grew from 0.2 million person-years to 0.460 2 million person-years，with AAPCs of 2.63%，2.78%，and 2.75%，respectively. In 2021，the numbers of incident cases，prevalent cases，and YLDs were 0.577 9 million，4.930 3 million，and 0.095 9 million person-years in the United States，and 13.787 6 million，112.502 million，and 2.235 7 million person-years globally. China’s ASIR decreased from 363.07/100 000 to 299.14/100 000（AAPC -0.60%），and ASYR from 57.33/100 000 to 45.84/100 000（AAPC -0.70%），both of which were higher than those in the United States but lower than the global level. Age-specific analyses showed declining incidence and YLD rates across all age groups in China，while certain age groups in the United States demonstrated increasing trends. From 1990 to 2021，the proportion of YLDs attributable to BPH among seven urological diseases in China rose from 61.4% to 69.2%. In 2021，YLDs due to prostate cancer accounted for the highest proportion among seven urinary system diseases in the United States，reaching 54.5%. Projections indicate that although ASIR and ASYR in China will decline from 2022 to 2040，the absolute numbers of incident cases and YLDs are projected to continue to rise，reaching 4.97 million and 0.78 million，respectively，by 2040.Conclusions:Between 1990 and 2021，the number of incidence cases，prevalence cases，and YLDs of BPH in China increased markedly，while ASIR and ASYR declined. The disease burden of BPH remains substantial，with a higher proportion of YLDs among urological diseases compared with the United States. By 2040，the number of BPH cases and YLDs in China is projected to further increase，underscoring the need for greater public health attention.

Objective:To investigate the clinical diagnosis and treatment of granulomatous prostatitis（GP）in patients with Prostate Imaging Reporting and Data System（PI-RADS）scores ≥ 4 on magnetic resonance imaging（MRI）.Methods:The data of 12 GP patients with PI-RADS score ≥ 4 who were admitted to Beijing Chaoyang Hospital，Capital Medical University，from February 2015 to February 2025，were retrospectively analyzed. The patients were aged 51?73 years（mean 66 years）. Presenting complaints included elevated prostate-specific antigen（PSA）levels in 6 cases，prostatic mass in 2 cases，urinary retention in 3 cases，and gross hematuria in 1 case. All 12 patients had concomitant lower urinary tract symptoms. Medical history revealed pulmonary tuberculosis in 2 cases，testicular tuberculosis in 1 case，close contact with tuberculosis in 1 case（spouse diagnosed with pulmonary tuberculosis 5 years earlier），allergic granulomatous vasculitis in 1 case，and intravesical bacillus Calmette-Guérin（BCG）instillation in 1 case. Digital rectal examination（DRE）showed gradeⅠprostatic hyperplasia in 2 cases，grade Ⅱ in 9 cases，and grade Ⅲ in 1 case. Nodules were palpable in 6 patients. The median PSA was 7.20 ng/ml（ranging 1.11?21.90 ng/ml），with 2 cases < 4 ng/ml. Transrectal ultrasound was performed in 10 patients，and prostate volumes were ranging from 29.48 to 109.78 cm3，with 6 cases > 45 cm3. All 12 patients underwent MRI，and all demonstrated PI-RADS scores ≥ 4，typically presenting as low signal intensity on T2-weighted imaging，high signal on diffusion-weighted imaging（DWI），and low apparent diffusion coefficient（ADC）values. Contrast-enhanced MRI in 8 cases revealed heterogeneous enhancement. One patient underwent 68Ga-prostate-specific membrane antigen positron emission tomography-computed tomography（ 68Ga-PSMA PET-CT），which showed band-like increased uptake in the central zone. All 12 patients were preoperatively suspected of prostate cancer，of whom 10 underwent transrectal biopsy and 2 underwent transperineal biopsy. Pathological characteristics and follow-up results were analyzed. Treatment outcomes were analyzed，The International Prostate Symptom Score（IPSS），quality of life（QOL）score，maximum urinary flow rate（Q max），and post-void residual urine（PVR）volume were compared before and 1 month after treatment. Results:Histopathology confirmed GP in all cases，with chronic inflammation in 11 cases and acute inflammation in 1 case. Immunohistochemistry demonstrated positivity for CD68（macrophage marker），high-molecular weight cytokeratin（HCK），and reticulin staining；periodic acid-Schiff（PAS）and acid-fast staining were positive in 2 cases，corresponding to 1 patient with a prior history of pulmonary tuberculosis and 1 with testicular tuberculosis. Two patients underwent thulium laser enucleation of the prostate，while 10 received conservative treatment，including 2 patients with tuberculosis infection who were referred for anti-tuberculosis therapy and 8 patients treated with oral tamsulosin 0.2 mg once daily. Follow-up was completed in 10 patients：9 were followed for 1 ? 3 months（mean 2.4 months），and 1 patient was followed for 9 years before being diagnosed with prostate cancer. Two additional patients，whose pathological findings suggested a possible diagnosis of tuberculous granulomatous prostatitis，were advised to undergo anti-tuberculosis treatment at another hospital and were subsequently lost to follow-up. Among the 2 patients who underwent thulium laser enucleation，IPSS decreased from 26 and 25 to 6 and 5 respectively，QOL scores decreased from 6 and 5 to 1 and 0 respectively，Q max increased from 4.5 and 4.3 ml/s to 23.0 and 21.9 ml/s respectively. In the 8 patients treated conservatively，IPSS decreased from 18.45±7.17 to 14.45±5.03，and QOL score decreased from 5.09±1.04 to 4.09±0.70 at 1 month after treatment，showing significant improvement（ P < 0.05）. Additionally，one patient initially diagnosed with GP and managed conservatively remained stable for 9 years，but subsequently developed urinary retention and underwent thulium laser enucleation，with postoperative pathology confirming prostate cancer. Conclusions:Clinical manifestations of GP are nonspecific，and the condition can easily be mistaken for prostate cancer due to elevated PSA levels and PI-RADS scores ≥4. Some patients may present with acute urinary retention，but definitive diagnosis still relies on prostate biopsy and immunohistochemistry. Treatment should be individualized according to the underlying etiology，with medication as the mainstay，while transurethral surgical intervention may be considered in cases with obstruction. Although GP is a benign lesion，its potential association with prostate cancer warrants vigilance and emphasizes the importance of long-term follow-up.

Objective:To explore the predictive factors for testicular atrophy in children with testicular torsion following orchiopexy.Methods:The clinical data of 82 patients with testicular torsion and orchiopexy admitted to Beijing Children’s Hospital Affiliated to Capital Medical University between October 2015 and September 2021 were retrospectively analyzed. The age was 147（110，162）months. Among these patients，62 presented with scrotal pain as the initial symptom，while 20 exhibited atypical symptoms. Regarding referral history，36 cases had no referrals，39 cases had one referral，and 7 cases had two or more referrals. Preoperative testicular ultrasonography revealed homogeneous echotexture in 24 cases and heterogeneous echotexture in 58 cases. Testicular blood flow was normal in 3 cases，reduced in 17 cases，and absent in 62 cases. Testicular torsion was considered at first diagnosis，testicular exploration was performed，and testicular fixation was performed if the testicle was viable. If bilateral testicular ultrasound examination was performed over 3 months after the operation，and the results showed that the difference in volume（TVL）between the affected testicle and the unaffected testicle was >50% or the blood flow in the affected testicle was absent，it was defined as testicular atrophy. If no ultrasound examination was performed over 3 months after the operation，but the ultrasound examination within 3 months after the operation indicated the absence of blood flow in the affected testicle，it was also defined as testicular atrophy. Univariate analysis was used to compare the clinical data between the two groups according to whether there was testicular atrophy or not. Multivariate logistic regression was used to analyze the independent risk factors associated with postoperative testicular atrophy. The predictive value of each factor was analyzed by receiver operating characteristic（ROC）curve.Results:Of the 82 patients，32（39.0%）had testicular atrophy after surgery.Patients presenting with atypical initial symptoms exhibited a significantly higher incidence of testicular atrophy compared to those with scrotal pain［75.0%（15/20）vs. 27.4%（17/62）， P<0.001］. Additionally，patients who underwent ≥2 referrals demonstrated a markedly elevated rate of testicular atrophy relative to those with 0 or 1 referral［100.0%（7/7）vs. 33.3%（12/36）vs. 33.3%（13/39）， P=0.002］. The incidence of testicular atrophy varied significantly depending on the level of the hospital where the patient was initially diagnosed：primary hospitals（100.0%，5/5），secondary general hospitals（50.0%，6/12），tertiary general hospitals（34.8%，8/23），and tertiary women and children’s hospitals（31.0%，13/42），with statistical significance（ P=0.020）. Furthermore，patients with uneven testicular echogenicity preoperatively were more likely to develop testicular atrophy than those with uniform echogenicity［55.2%（32/58）vs. 0， P<0.001］. Preoperative testicular ultrasonography revealed a significant difference in the rate of testicular atrophy among patients with absent blood flow，reduced blood flow，and normal blood flow［50.0%（31/62）vs. 5.9%（1/17）vs. 0， P=0.001］. Patients experiencing testicular atrophy had a longer preoperative preparation time compared to those without atrophy［median 4.0（3.4，5.1）h vs. 3.5（3.0，4.2）h， P=0.017］. Moreover，the duration of symptoms was significantly longer in patients with testicular atrophy than in those without［25.5（13.0，49.5）h vs. 8.0（6.3，11.8）h， P<0.001］. Finally，contralateral testicular fixation was associated with a higher incidence of testicular atrophy，with a statistically significant difference observed between groups［50.0%（23/46）vs. 25.0%（9/36）， P=0.038］. Multivariate logistic regression analysis revealed that preoperative testicular ultrasound blood flow loss（ OR = 1.22， P = 0.034），uneven testicular ultrasound echo（ OR = 1.33， P = 0.007），and not performing contralateral testicular fixation（ OR = 0.77， P = 0.003）were independent predictors of postoperative testicular atrophy. The area under the curve（AUC）for predicting postoperative testicular atrophy was 0.68，0.74，and 0.63，respectively. Conclusions:Lack of preoperative testicular ultrasound blood flow and uneven preoperative testicular ultrasound echo have good predictive value for testicular atrophy after testicular torsion testicular fixation in children，and the best predictor is uneven preoperative testicular ultrasound echo. The correlation between contralateral testicular fixation and postoperative testicular atrophy needs further study.

The most common site of bone metastasis in advanced bladder cancer is spine，and jaw metastasis is rare. This article reports a 77-year-old male patient who had a solitary metastatic lesion in the left jaw 1 year after radical cystectomy for bladder cancer. The pathological features of the metastasis were consistent with bladder urothelial carcinoma metastasis. The patient received a GC regimen combined with toripalimab immunotherapy for 4 cycles，followed by maintenance of immunotherapy and anti-bone metastasis protection therapy. No new metastasis was found during the 6-month follow-up.

Enterococcus faecalis is distributed in the intestines and rarely becomes a pathogen of spinal infection. This article reports a case of delayed spinal enterococcus faecalis infection caused by transperineal prostate biopsy. The patient was found to have a serum tPSA level of 33.418 ng/ml during prostate cancer screening. A prostate biopsy was performed，and the pathological result was benign prostatic hyperplasia. One month after the operation，the patient presented with recurrent low back pain. Contrast-enhanced MRI of the lumbar spine showed infectious lesions of the T12 and L1 vertebrae with pathological compression fractures. A puncture biopsy of the diseased vertebra was performed，and the metagenomic test showed enterococcus faecalis infection. Anti-infection and bed rest conservative treatment were given. Follow-up for 1 year showed fracture healing and infection control.

Urinary incontinence is a common complication after radical prostatectomy，which seriously affects the quality of life of patients. As a simple and convenient reconstruction technique，the anterior suspension stitch technique can improve the early recovery of urinary continence by providing anterior support and stabilizing the urethral position. This article will review the proposal，innovative development of this technique and the application of the emerging suspension stitch technique in radical prostatectomy.

Objective:To evaluate the role of whole exome sequencing（WES）in the etiological diagnosis and precision medicine management of patients with urolithiasis.Methods:We conducted a retrospective review of 21 patients with urolithiasis and pathogenic gene mutations identified by WES at The Second Affiliated Hospital of Zhengzhou University between April 2019 and March 2025. The cohort included 13 males and 8 females，with a mean age of（18.9 ± 11.1）years；18 patients were under 25 years old. Clinical presentations included nephrocalcinosis（8 patients）and urinary tract calculi（13 patients），with five patients exhibiting extra-renal manifestations such as renal tubular acidosis and hyperaldosteronism. Stone composition analysis identified calcium oxalate（16 patients），cystine（4 patients），and carbonate apatite（1 patient）. Metabolic abnormalities were prevalent，including hypocitraturia（11 patients），hyperoxaluria（8 patients），and hypercalciuria（7 patients），with eight patients presenting two or more concurrent disorders. All patients underwent WES and comprehensive metabolic evaluation. Sequencing was performed on an Illumina Hiseq4000 platform，achieving a mean depth of > 100× and coverage of > 98% in target regions. Variants were classified according to the American College of Medical Genetics and Genomics（ACMG）guidelines.Results:WES identified 12 distinct genes across autosomal recessive（9 genes： AGXT， GRHPR， ATP6V1B1， SLC12A1， KCNJ1， SLC3A1， SLC7A9， SLC34A3， WFS1），autosomal dominant（2 genes： CASR， ADCY10），and X-linked recessive（1 gene： CLCN5）inheritance patterns. Genotype-phenotype correlations revealed mutations associated with primary hyperoxaluria（8 patients），hypercalciuria（7 patients），and renal malformation due to a WFS1 mutation（1 patient）. A positive genetic diagnosis was achieved in 100% of patients with either urinary oxalate > 1 000 μmol/24 h or cystine stones. 8 patients received a diagnosis of hereditary stone disease at their first presentation（non-delayed group），while 13 experienced a mean diagnostic delay of（9.6 ± 3.9）years. The delayed diagnosis group had a significantly older age at initial stone onset［（10.2 ± 5.3）years vs.（6.8 ± 3.1）years， P = 0.03］and a higher incidence of impaired renal function（6 patients vs. 1 patient， P = 0.04）. Analysis of diagnostic delay by gene subgroup showed delays in 2/4 patients with cystinuria［ SLC3A1/ SLC7A9；（8.2 ± 3.5）years］，5/8 with primary hyperoxaluria［ AGXT/ GRHPR；（10.5 ± 4.1）years］，5/7 with hypercalciuria-related genes［ CASR/ ADCY10/ SLC12A1/ KCNJ1/ SLC34A3；（9.8 ± 3.8）years］，and 1/2 with other genes［ ATP6V1B1/ WFS1/ CLCN5；（7.6 ± 2.2）years］. Among 32 mutation sites detected，21 were classified as pathogenic/likely pathogenic and 11 as variants of uncertain significance. Four novel mutations were identified： ATP6V1B1（presenting with renal tubular acidosis，nephrocalcinosis，and hypocitraturia）， WFS1（presenting with renal malrotation，hydronephrosis，and stones without metabolic abnormalities）， SLC12A1（presenting with Bartter syndrome type 1，chronic renal insufficiency，hypercalciuria，hypocitraturia，alkalosis，and hyperaldosteronism），and SLC3A1（presenting with bilateral renal stones and cystinuria）. Conclusions:WES is crucial in identifying the underlying etiology of urolithiasis and can guide targeted treatment. We recommend early WES for patients with an initial stone presentation before age 25，those with nephrocalcinosis，or those with abnormal metabolic workups to facilitate precise diagnosis and preventive care.

Urolithiasis represents a prevalent clinical challenge marked by high recurrence rates and morbidity，with existing preventive strategies struggling to effectively curb its epidemic trajectory，thereby posing a significant threat to public health. The etiology of this condition is intricate，involving a complex network of interactions spanning classical supersaturation-crystallization theory，Randall’s plaque theory，and multifactorial elements such as cellular injury，inflammatory responses，metabolic derangements，the gut-kidney axis，immune dysregulation，and genetic predisposition. However，the critical mechanisms initiating stone formation and the early pathophysiological processes remain incompletely elucidated，constituting the core impasse in current preventive strategies. This review systematically synthesizes classical theories and cutting-edge advancements in urolithiasis etiology research，emphasizing the urgent need to integrate emerging technologies，including high-dimensional omics，advanced imaging modalities，and artificial intelligence，to dissect pivotal pathological nodes in early stone formation. Such interdisciplinary efforts are essential to overcome cognitive bottlenecks and ultimately achieve personalized，precision-based prevention strategies.

The core update of the 2025 edition of the European Association of Urology（EAU）Guidelines on Urolithiasis is reflected in the addition of a new section titled "Genetic Factors and Testing"，which systematically defines the clinical application standards for genetic testing in urolithiasis. Given the significant impact of genetic factors on the pathogenesis of urolithiasis，the guidelines recommend genetic testing for specific populations，including urolithiasis patients aged ≤ 25 years，adult patients aged > 25 years with suspected hereditary or metabolic diseases，patients with recurrent stones，bilateral stones，or a family history of urolithiasis. In terms of testing technology，the guidelines suggest using next-generation sequencing（NGS）technology to identify pathogenic genetic variants，while emphasizing that testing should be combined with patients’ metabolic assessment and professional genetic counseling to improve diagnostic accuracy. If hereditary urolithiasis is confirmed，further genetic screening of the patient’s family members is required. The guideline update of this newly added section provides precise guidance on genetic testing for the clinical diagnosis and treatment of urolithiasis，which is conducive to promoting the practice of personalized treatment for urolithiasis and thereby improving the clinical diagnosis and treatment.