Cushing’s syndrome (CS) during pregnancy is rare. It causes the clinical disorder by overproduction of cortisol. Hypercortisolemia in pregnancy can lead to severe complications, both for the mother and the fetus, including spontaneous abortion, perinatal death, prematurity, maternal hypertension, heart failure, diabetes and opportunistic infections. The most common cause of hypercortisolemia in pregnancy is a cortisol-secreting adrenal tumor. Herein we present a 31 year-old female patient, at 20 weeks’ gestation, with CS secondary to a left adrenal tumor. A brief review of reported similar cases is included.

Background: Glutathione S-transferase Pi-1 (GSTP1) methylation is detectable in prostate cancer (PCa) tissues, blood, and urine post-prostate massage, with elevated levels in urine samples. But its role in urine samples for PCa diagnosis is still unclear. This study aimed to investigate the clinical significance of urine-based automated detection of GSTP1 methylation technology in the diagnosis of clinical suspected PCa patients. Methods: A retrospective study was performed on 120 patients who underwent prostate biopsy at The University of Hong Kong-Shenzhen Hospital from September 2022 to June 2024. All patients underwent digital rectal examination (DRE) prior to biopsy, with post-DRE urine samples used for GSTP1 methylation testing. Using biopsy pathology as the gold standard, we compared the sensitivity, specificity, and accuracy of urinary GSTP1 methylation with prostate-specific antigen (PSA) for diagnosing PCa. Additionally, we developed a diagnostic prediction model integrating urinary GSTP1 methylation and PSA to assess the combined method’s value in enhancing diagnostic efficacy. Results: The sensitivity and specificity of urinary GSTP1 methylation for PCa diagnosis were 81.4% and 83.6%, respectively, with positive predictive value (PPV) of 82.8% and accuracy of 82.5%. In contrast, PSA had sensitivity and specificity of 67.8% and 54.1%, respectively, with PPV of 58.8% and accuracy of 60.8%. Urinary GSTP1 methylation showed no significant difference in sensitivity compared to PSA (P=0.16) but significantly higher specificity (P=0.001). In the PSA gray zone (4.0–10.0 ng/mL), GSTP1 methylation had sensitivity and specificity of 87.5% and 86.2%, respectively, achieving accuracy of 86.7%, demonstrating good diagnostic efficacy. The area under the curve (AUC) for the combined urinary GSTP1 methylation and PSA method was 0.89 [95% confidence interval (CI): 0.84–0.95], P<0.001, significantly superior to PSA alone, notably improving diagnostic efficacy. Conclusions: Automated detection of urinary GSTP1 methylation significantly enhanced PCa diagnostic value, outperforming PSA in sensitivity, specificity, and accuracy. Combining urinary GSTP1 methylation with PSA notably improved accuracy, especially in the PSA gray zone (4.0–10.0 ng/mL), demonstrating excellent efficacy. This non-invasive, easily performed method showed high diagnostic efficacy, indicating strong clinical potential.

Background: Enhanced recovery after surgery (ERAS) has been widely applied in various surgical fields to improve postoperative recovery and reduce complications. However, its application in retroperitoneal laparoscopic resection of adrenal tumors remains limited. This study aimed to evaluate the effect and value of the 4N-ERAS protocol, which includes no Foley catheter, no drainage, no antibiotics, and “no pain” management for the postoperative recovery of patients undergoing retroperitoneal laparoscopic adrenal tumors resection. Methods: We retrospectively analyzed data from 85 patients with adrenal tumors who were treated in the Urology Department of The University of Hong Kong-Shenzhen Hospital from January 2019 to December 2023. Of them, 42 patients were treated with the 4N-ERAS protocol (4N-ERAS group) and 43 patients received traditional treatment (control group). We compared clinical characteristics, such as sex, age, mean body mass index (BMI), preoperative diagnosis, tumor size, tumor location, and postoperative outcomes, including time to first flatus, time to first ambulation, time to Foley catheter removal, time to retroperitoneal drainage tube removal, postoperative pain score [Numeric Rating Scale (NRS)], length of hospital stay, total hospitalization costs, and postoperative complications between the two groups. Results: There were no significant differences in terms of clinical characteristics between the two groups. Compared to the control group, the 4N-ERAS group exhibited shorter times for first flatus, first ambulation, Foley catheter removal, retroperitoneal drainage tube removal, lower postoperative pain scores (NRS), and shorter hospital stays (P<0.05). Furthermore, compared to the control group, the total hospitalization cost was significantly lower in the 4N-ERAS group (P<0.05). There were no significant differences in terms of postoperative complications between the two groups (P=0.19). Conclusions: The 4N-ERAS protocol for retroperitoneal laparoscopic resection of adrenal tumors may expedite postoperative recovery, reduce pain, and lower overall hospital costs. This preliminary study demonstrated the safety and feasibility of the 4N-ERAS protocol for retroperitoneal laparoscopic resection of adrenal tumors, warranting future multicenter prospective, randomized, controlled trials in this field.

Background: Embryonal rhabdomyosarcoma (ERMS) of the prostate is a rare and aggressive malignant tumor in adults with a poor prognosis in general. The main presenting symptoms are dysuria and acute urinary retention. Prostate ERMS is easily misdiagnosed, which leads to delays in treatment. Case Description: We report the case of a previously healthy 31-year-old man who presented with dysuria for 3 months. Digital rectal examination (DRE), ultrasound, and computed tomography (CT) were suggestive of the possibility of a 2.0 cm × 3.0 cm abscess in the left lobe of the prostate. Prostate-specific antigen (PSA) was at a normal level, and C-reactive protein (CRP) concentration was elevated. The patient underwent surgical drainage by transurethral incision of the prostatic abscess. There was a significant improvement in the maximal urinary flow rate on postoperative day 5. However, the patient presented with acute urinary retention again on the 20th postoperative day. DRE and pelvic magnetic resonance imaging (MRI) showed a recurrence of an enlarged mass in the left lobe of the prostate. PSA level was again normal. Cystoscopy revealed a large neoplasm arising from the prostate obstructing the bladder outlet, and a diagnostic transurethral resection of this prostate tumor was performed. Histopathology revealed the mass to be an embryonic rhabdomyosarcoma. Subsequently, the patient was transferred to the Oncology Department and received chemoradiotherapy. After chemoradiotherapy, the size of the prostate became normal. Unfortunately, the patient deteriorated rapidly and eventually succumbed to multiple organ failure 1 year after the initial presentation. Conclusions: Due to its non-specific presenting symptoms, prostate ERMS can be easily misdiagnosed, which can lead to treatment delay. Multimodality approaches, including neoadjuvant/adjuvant chemotherapy, radiotherapy, and radical resection, can improve the survival rate and reduce ERMS patient mortality.

Objective: To explore the clinical application of enhanced recovery after surgery (ERAS) in bipolar transurethral vaporization of the prostate (B-TUVP) and its impact on postoperative recovery. Methods: A retrospective analysis was conducted on the clinical data of 212 patients with benign prostatic hyperplasia (BPH) admitted to the Department of Urology of our hospital from January 2019 to December 2024. Among them, 121 patients were managed under an ERAS protocol (ERAS group), and 91 patients received traditional perioperative care (control group). The clinical characteristics included age, mean body mass index (BMI), preoperative comorbidities, prostate volume (PV), preoperative International Prostate Symptom Score (IPSS), preoperative Quality of Life (QoL) score, preoperative urinary flow rate, and urodynamic parameters. Preoperative management, intraoperative management, and postoperative outcomes were compared between the two groups. Results: The clinical baseline data showed no significant differences between the two groups. Compared with the control group, the ERAS group had a significantly shorter duration of continuous bladder irrigation, time to first ambulation, and postoperative length of stay ( P < 0.001). The total hospitalization costs were also significantly lower in the ERAS group compared to the control group ( P < 0.01). There was no significant difference in the incidence of postoperative complications between the two groups. Conclusion: The application of the ERAS protocol in B-TUVP can promote postoperative recovery, reduce the postoperative length of stay, and decrease total hospitalization costs. However, more prospective randomized controlled trials are needed to further validate the feasibility and effectiveness of this protocol.