The incremental value of PI-RADS for predicting adverse pathology at radical prostatectomy in men diagnosed through systematic biopsy remains uncertain. We assessed whether PI-RADS improves discrimination beyond age, MRI-derived prostate-specificantigen density (PSAD), biopsy Grade Group, and quantitative biopsy tumour burden. This retrospective study included 284 men undergoing 1.5-T mpMRI, systematic biopsy, and radical prostatectomy between January 2020 and January 2026. Adverse pathology comprised prostatectomy Grade Group ≥ 3 and/or stage ≥ pT3a. Three logistic models were compared: age/PSAD/biopsy grade/tumour burden; age/PSAD/PI-RADS; and their combination. Internal validation used 2000 bootstrap samples. Adverse pathology occurred in 143 patients (50.4%). Apparent AUCs were 0.790 (95% CI 0.737–0.843), 0.713 (0.653–0.773), and 0.799 (0.747–0.851); optimism-corrected AUCs were 0.781, 0.703, and 0.787. Adding PI-RADS ≥ 4 yielded an adjusted OR of 1.996 (95% CI 1.150–3.465) and an apparent AUC difference of 0.009 (95% CI −0.015 to 0.033; descriptive DeLong p = 0.469). The combined model had a corrected calibration slope of 0.915 and Brier score of 0.187. PI-RADS from routine 1.5-T mpMRI was independently associated with adverse pathology, but its incremental discrimination beyond clinical and systematicbiopsy variables was small and uncertain. These findings concern a surgery-selected systematicbiopsy pathway, do not estimate the overall value of MRI, and require external validation.

Digital health literacy (e-HL) is an increasingly popular analysis of patients' awareness of appropriate treatment modalities. This study aimed to evaluate e-HL levels in men undergoing Holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and its potential impact on their quality of life. A total of 106 patients scheduled for HoLEP were included. Age, body mass index (BMI), prostate-specific antigen (PSA), prostate volume, preoperative uroflowmetry values, e-HL scores, International Standard Classification of Education (ISCED) levels, and internet usage data were recorded. The EuroQoL Quality of Life (EQ-5D-5L) questionnaire was administered at three months postoperatively. Follow-up uroflowmetry results, IPSS scores, and quality of life (QoL) assessments were compared with e-HL scores. A cutoff value for digital health literacy was identified. The mean age was 68 years, BMI 29.1 kg/m², prostate volume 86.6 cc, and PSA 7.5 ± 4.6 ng/ml. The mean e-HL score was 16.8 ± 9.8, which was negatively correlated with age and BMI, positively with ISCED level and internet use (p < 0.001). The cutoff for adequate e-HL was 18.5. No significant correlation was found between e-HL and postoperative IPSS, EQ-5D-5L scores. e-HL levels in HoLEP patients were not associated with symptom severity, postoperative outcomes, or quality of life. Further multicenter studies are needed.

Background/Objectives: Urinary system stone disease is common and highly recurrent, and body mass index (BMI) poorly reflects the central adiposity linked to stone risk. We compared BMI with five next-generation anthropometric indices (A Body Shape Index [ABSI], Body Roundness Index [BRI], Waist-to-Height Ratio [WtHR], Conicity Index [ConI], Waist-to-Hip Ratio [WHR]) for their association with stone disease, and developed a hybrid autoencoder-based artificial intelligence model integrating anthropometric, clinical, and lifestyle data. Methods: This multicenter case–control study included 1195 participants (562 stone cases, 633 controls) from six centers in Turkey. Thirty-one variables were grouped into three subgroups (basic measurements, derived indices, clinical/lifestyle data), each processed by a separate autoencoder; combined features were classified with XGBoost, Cubic SVM, Fine KNN, and logistic regression. Each index’s independent association was assessed by quartile-based logistic regression, and discriminative power by ROC/AUC. Results: BMI showed no between-group difference (p = 0.919) or discriminative power (AUC = 0.498). ABSI, BRI, WtHR, ConI, and WHR were all significantly higher in the stone group, showed positive trends across quartiles after full adjustment (all p-trend ≤ 0.001), and outperformed BMI (AUC 0.547–0.564); associations were strongest for ConI (aOR = 2.62) and ABSI (aOR = 2.57). The hybrid AI model performed best with XGBoost (77% accuracy), followed by Fine KNN (71%), logistic regression (69%), and Cubic SVM (68%). Conclusions: Unlike BMI, next-generation indices reflecting central adiposity are independently and consistently associated with stone disease, and a multivariable AI model combining anthropometric, clinical, and lifestyle data reached 77% accuracy in separating stone patients from controls on a single test split. These findings are a hypothesis-generating risk-stratification signal that requires external validation, and they do not support clinical screening.

Objective: Patients undergoing radical prostatectomy generally belong to an older population; therefore, in addition to chronological age, frailty has a substantial impact on clinical outcomes. This study aimed to evaluate the predictive value of the modified frailty index (mFI-5) for post-operative complications and functional outcomes in patients undergoing radical prostatectomy.Materials and Methods: A retrospective analysis was conducted on 200 individuals who underwent radical prostatectomy between January 2016 and January 2024 in a high-volume tertiary center. Data collection included demographic characteristics, comorbidity profiles, histopathological findings, perioperative variables, postoperative complications and follow-up outcomes. Patients were stratified as having either high risk (≥ 2) or low risk (< 2) according to pre-operative mFI-5 scores. Postoperative complications constituted the primary endpoint, whereas functional outcomes were assessed as secondary endpoints.Results: The study included 200 male patients, with a mean age of 64.7 ± 6.03 years. Fifty-four out of 200 patients (27%) were in the high-risk group (mFI-5 ≥ 2) while 146 patients (73%) were in low-risk group (mFI-5 < 2). While the rate of major complications (Clavien-Dindo ≥ 3) was significantly higher in high-risk group, the overall complication rate was similar between the groups. Readmission and reoperation rates were increased in the high-risk group; however, the difference did not reach statistical significance. Regarding functional outcomes, erectile dysfunction and urinary incontinence rates were similar between the groups.Conclusion: This study highlights an association between higher mFI-5 scores and an increased risk of major postoperative complications after radical prostatectomy. Although mFI-5 should not be used as a stand-alone criterion for treatment selection, it may serve as a simple, rapid, and cost-effective adjunctive tool for preoperative risk stratification and individualized surgical decision-making.