This month, Urogenital Tract Infection presents an in-depth exploration of the resistance mechanism of urinary tract infections (UTIs) and features the latest updates from leading authors around the world. Here, you will find 3 review articles, 1 original article, 1 case report, and a letter contributed by preeminent researchers from around the world.

Professor Jin Bong Choi of Catholic University of Korea explains that syphilis diagnosis should integrate comprehensive clinical evaluation and serological testing, while paying attention to diagnostic challenges such as early latent infection, serum antibody status, and human immunodeficiency virus coinfection. Penicillin G remains the mainstay of treatment, and treatment regimens are adjusted based on disease stage and presence of central nervous system involvement. From a public health perspective, a multifaceted approach, including improved surveillance systems, targeted testing of high-risk groups, and inclusion of syphilis testing within broader sexually transmitted infection control systems, is essential to curb the resurgence of syphilis.

Dr. Byoung-Kyu Han of Perfect Urology Clinic of Korea reports a correlation between prostatic inflammation and prostate-specific antigen (PSA) levels. Preferential use of magnetic resonance imaging (MRI) improves the detection of clinically significant prostate cancer while reducing overdiagnosis and allowing for deferral of biopsy in cases of negative MRI results under structured monitoring. PSA concentration, in conjunction with MRI, improves triage, with a practical operating threshold of approximately 0.10–0.20 ng/mL/cm³ adjusted for MRI quality and pre-examination risk. Validated secondary biomarkers (e.g., PHI, 4Kscore, IsoPSA, Stockholm3, Proclarix, PCA3, SelectMDx, ExoDx, MPS/MPS2) are best used selectively when MRI results are negative or equivocal and clinical risk is uncertain.

Professor Ji Hyun Kim of Wake Forest University School of Medicine, USA, believes that current standard treatments, such as dialysis and kidney transplantation, have significant limitations and fail to meet clinical needs, and seeks solutions in regenerative medicine. One approach focuses on enhancing the kidney's limited intrinsic regenerative capacity by shifting the damage response away from maladaptive repair pathways. This strategy is made possible by recent advances in understanding the molecular and cellular mechanisms underlying kidney injury and repair. Several pharmacological interventions have been proposed to mitigate fibrosis and promote cellular recovery after injury. A second major strategy is stem cell-based therapies, based on the identification of renal progenitor cell populations and increasing insight into the renal protective, immune-modulating, and regenerative paracrine effects of mesenchymal stem cells. Collectively, these efforts lay the foundation for biologically informed therapies that move beyond symptomatic treatment and toward true kidney regeneration.

Dr. Seung-Kwon Choi of Seoul Medical Center of Korea retrospectively analyzed 84 patients diagnosed with Fournier's gangrene at 7 hospitals from 2008 to 2022. The mean age was 58.1±15.9 years, and 95.2% of patients were male. Sepsis occurred in 38.1% of patients, and the overall mortality rate was 14.3%. In univariate analysis, age ≥70 years, low body mass index, diabetes, hypoglycemia, hypoglycemia, high respiratory rate, and French Gastrointestinal Disease Severity Index (FGSI)≥9 were significantly associated with mortality. After data adjustment and multivariate adjustment, diabetes (odds ratio [OR], 39.61; 95% confidence interval [CI], 2.39–656.32; p=0.010) and respiratory rate (OR, 1.44; 95% CI, 1.09–1.91; p=0.011) were identified as independent predictors of mortality. FGSI≥9 showed a borderline association with mortality (p=0.08), suggesting that FGSI may be clinically significant. The results suggest that it may serve as a useful severity indicator for early risk stratification.

Professor Jong Kil Nam of Pusan National University of Korea reports a case of primary focal amyloidosis confined to the urinary tract. A 69-year-old woman with recurrent gross hematuria for 2 years and a presumed diagnosis of chronic cystitis underwent transurethral resection. A left ureteral mass with hydronephrosis was discovered, raising the possibility of malignancy. Histopathologic examination of bladder and ureteral specimens revealed amorphous eosinophilic deposits that stained positive for Congo red and exhibited apple-green birefringence under polarizing light microscopy. Immunofluorescence revealed λ-light chain predominance, confirming light chain amyloidosis without systemic involvement. The patient underwent complete endoscopic resection and remains asymptomatic during follow-up. This case highlights the diagnostic challenges of focal urinary amyloidosis and emphasizes the importance of histologic confirmation in atypical inflammatory lesions.

Professor Dong-Hoon Lim of Chosun University of Korea contributed a letter regarding the diagnostic performance of the Sysmex UF-5000 for acute bacterial prostatitis. He noted that the thresholds used for UF-5000 parameters were determined retrospectively using receiver operating characteristic curve analysis, which is a suitable exploratory approach but leaves room for overfitting, especially given the relatively small cohort analyzed. He also noted that while the 85.7% concordance rate for Gram classification was encouraging, further characterization of the discrepant results could provide useful clinical insights. He noted that differences in bacterial morphology, mixed infections, and low bacterial counts could contribute to misclassification. He suggested that addressing these 2 issues could yield better results.

Therefore, we have summarized the general overview and key information of the papers published this month. In particular, Professor Ji Hyun Kim 's review paper was selected as an editor's recommendation because it is expected to broaden the reader's perspective on this field. As UTI is increasingly recognized internationally, I ask for the interest and support of experts in urogenital infections and inflammations who are looking for fresh and useful information in the field of urogenital infections and inflammations.

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