A rare cause of hematuria; a case report of sarcoidosis

A rare cause of hematuria; a case report of sarcoidosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A rare cause of hematuria; a case report of sarcoidosis Yaşar İncekara, Erdoğan Çetinkaya, İsmail Ulus, Mustafa Çörtük, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7607565/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Sarcoidosis is a chronic multisystem granulomatous disease most frequently involving the lungs and hilar lymph nodes. Genitourinary involvement, especially bladder sarcoidosis, is extremely rare. Case Presentation: We report a 52-year-old female with a history of pulmonary sarcoidosis who later developed hematuria. Initial thoracic imaging and CP-EBUS revealed non-caseating granulomatous inflammation, consistent with sarcoidosis. After six years of follow-up, the patient developed urinary symptoms. Cystoscopy revealed raised bladder lesions, and biopsy confirmed chronic non-caseating granulomatous inflammation. The patient was treated with corticosteroids and later azathioprine was added due to persistent disease activity. Conclusion Bladder involvement in sarcoidosis is rare and often difficult to diagnose due to nonspecific findings. Careful monitoring of sarcoidosis patients, including assessment for urinary symptoms, is essential for early detection and timely management. Sarcoidosis Bladder Hematuria Case report Figures Figure 1 Figure 2 Introduction Sarcoidosis is a chronic multisystem granulomatous disease of unknown cause. The most commonly affected organs are the hilar lymph nodes (LN) and lungs (about 90% of all cases). The typical morphological finding is multiple non-caseating granulomas formed by fibroblasts, lymphocytes, and macrophages ( 1 ). The clinical manifestations of sarcoidosis vary considerably and depend on the affected organ, the number of organs involved, the severity of granulomatous infiltration, and whether fibrosis has developed along with functional impairment. In general, corticosteroids are the first-line treatment for patients requiring therapy. Although corticosteroids can maintain disease control in most sarcoidosis cases requiring long-term maintenance therapy, relapses may still occur. In patients who do not respond to corticosteroids, are corticosteroid-resistant, or cannot tolerate corticosteroid tapering, second-line agents such as antimalarials or immunosuppressants can be used as alternatives ( 2 ). This case report presents a patient initially without urological symptoms who, during follow-up, was diagnosed with bladder sarcoidosis, a rare form of involvement. Case Report A 52-year-old female patient presented to the clinic with complaints of fatigue and cough lasting for three months. A chest X-ray at the referring center revealed bilateral hilar fullness (Fig. 1 ), prompting referral for further investigation and treatment. The patient had a history of diabetes mellitus, treated with oral antidiabetic medication, and a history of thyroid surgery (thyroidectomy), requiring levothyroxine. No additional illnesses or medications were reported. Her family history was unremarkable. Physical examination showed normal respiratory sounds, with an oxygen saturation of 97% on room air, and other system examinations were within normal limits. Laboratory tests revealed an elevated serum angiotensin-converting enzyme (ACE) level of 93.9 U/L (reference range: 8–52 U/L), while other blood tests, including calcium, were within normal limits. Thoracic computed tomography (CT) showed bilateral hilar and mediastinal lymph nodes. A convex probe endobronchial ultrasound (CP-EBUS) was performed, revealing multiple conglomerated lymph nodes in the right paratracheal and subcarinal areas, the largest being 25 mm in diameter, with three samples taken from each site. Cytological findings were reported as consistent with non-caseating granulomatous inflammation. The patient was followed up without medication for six years. In a follow-up thoracic CT, a nodule with irregular borders, 1 cm in diameter, was observed in the medial segment of the right middle lobe, along with secondary pleuroparenchymal changes in the basal segments of both lower lobes. A PET-CT scan showed newly detected lymph nodes with moderate to intense hypermetabolism in supradiaphragmatic and infradiaphragmatic lymph node stations, consistent with granulomatous disease. Splenic hypermetabolism was also observed. Given the elevated serum ACE level (140 U/mL), the patient was started on methylprednisolone 20 mg once daily in 2019. During tapering, the patient developed dark-colored urine and hematuria, leading to referral to the urology clinic. Cystoscopy revealed raised mucosal lesions (Fig. 2 ), and biopsy confirmed chronic non-caseating granulomatous inflammation. Corticosteroid treatment was continued. Three months later, follow-up cystoscopy showed partial regression of the lesions. Azathioprine 50 mg/day was added after rheumatology consultation, while methylprednisolone was maintained at 4 mg/day. The patient’s follow-up and treatment are ongoing. Discussion Sarcoidosis is a multisystem inflammatory disease characterized by the formation of non-caseating granulomas. The most common sites of involvement are the lungs and hilar lymph nodes ( 3 ). Although many patients remain asymptomatic or require minimal therapy, sarcoidosis can affect almost any organ system. Genitourinary involvement, however, is rare ( 4 ). Bladder sarcoidosis is particularly uncommon and difficult to diagnose, as there are no specific laboratory or radiological markers ( 5 ). In the literature, only a limited number of bladder sarcoidosis cases have been reported, often presenting with hematuria or irritative urinary symptoms. Our patient initially had no urological complaints, but later developed hematuria, leading to the diagnosis. As with other organ involvement, corticosteroids remain the mainstay of treatment. Immunosuppressive agents, such as azathioprine, may be considered in patients with relapsing or refractory disease. Bladder involvement should be carefully monitored, as it can lead to hydronephrosis or, rarely, be associated with metachronous bladder cancers ( 5 ). Due to the lack of diagnostic tools beyond symptoms and histopathology, delayed diagnosis and underreporting of bladder sarcoidosis are possible. Therefore, clinicians should remain vigilant and include genitourinary evaluation in the follow-up of sarcoidosis patients. Conclusion Bladder sarcoidosis is an extremely rare manifestation of sarcoidosis and should be considered in patients presenting with new urinary symptoms during follow-up. Early recognition and appropriate management may prevent complications and improve outcomes. Declarations Consent to publish Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethics Statement Ethical approval was waived due to the single-patient case report nature. Competing of Interest The authors declare no competing of interest. Clinical trial registration Not applicable. Author Contribution Conceptualization, Y.İ.; methodology, Y.İ and E.Ç.; software, Y.İ.; validation, Y.İ.,R.E.; formal analysis, Y.İ and E.Ç.; investigation, Y.İ. and E.Ç; resources, Y.İ.; data curation, Y.İ , R.E.; writing—original draft preparation, Y.İ.; writing—review and editing, Y.İ. and M.Ç; visualization, M.Ç; supervision, Y.İ.; project administration, Y.İ. All authors have read and agreed to the published version of the manuscript. Data Availability The datasets generated and/or analysed during the current study are not publicly available due to institutional restrictions but are available from the corresponding author on reasonable request. References -) Skopelidou V, Hurník P, Židlík V, Tulinský L, Lenz J, Balner T. Unnecessary orchiectomy due to atypical sarcoidosis manifesting as a unilateral scrotal mass: a case report and literature review. Front Immunol. 2023;14:1253120. 10.3389/fimmu.2023.1253120 . PMID: 38090555; PMCID: PMC10711076. -) Motswaledi MH, Khammissa RA, Jadwat Y, Lemmer J, Feller L. Oral sarcoidosis: a case report and review of the literature. Aust Dent J. 2014;59(3):389–94. 10.1111/adj.12196 . Epub 2014 Jul 30. PMID: 24862235. -) Baughman RP, Valeyre D, Korsten P, Mathioudakis AG, Wuyts WA, Wells A et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J. 2021;58(6):2004079. doi: 10.1183/13993003.04079-2020. PMID: 34140301. -) Kalia V, Vishal K, Gill JS, Gill A. Ureteric sarcoidosis–a rare entity. Br J Radiol. 2010;83(996):e247–8. 10.1259/bjr/17908733 . PMID: 21088080; PMCID: PMC3473606. -) Block NL, Kava BR. Genitourinary sarcoidosis: An essential review for the practicing clinician. Indian J Urol. 2017 Jan-Mar;33(1):6–12. 10.4103/0970-1591.195724 . PMID: 28197023; PMCID: PMC5264196. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Nov, 2025 Reviewers agreed at journal 09 Nov, 2025 Reviewers invited by journal 30 Oct, 2025 Editor invited by journal 07 Oct, 2025 Editor assigned by journal 03 Oct, 2025 Submission checks completed at journal 03 Oct, 2025 First submitted to journal 13 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7607565","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":542275238,"identity":"e315d229-4c1b-47b1-8f3a-b66abaea59f3","order_by":0,"name":"Yaşar 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The most commonly affected organs are the hilar lymph nodes (LN) and lungs (about 90% of all cases). The typical morphological finding is multiple non-caseating granulomas formed by fibroblasts, lymphocytes, and macrophages (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The clinical manifestations of sarcoidosis vary considerably and depend on the affected organ, the number of organs involved, the severity of granulomatous infiltration, and whether fibrosis has developed along with functional impairment. In general, corticosteroids are the first-line treatment for patients requiring therapy. Although corticosteroids can maintain disease control in most sarcoidosis cases requiring long-term maintenance therapy, relapses may still occur. In patients who do not respond to corticosteroids, are corticosteroid-resistant, or cannot tolerate corticosteroid tapering, second-line agents such as antimalarials or immunosuppressants can be used as alternatives (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis case report presents a patient initially without urological symptoms who, during follow-up, was diagnosed with bladder sarcoidosis, a rare form of involvement.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 52-year-old female patient presented to the clinic with complaints of fatigue and cough lasting for three months. A chest X-ray at the referring center revealed bilateral hilar fullness (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), prompting referral for further investigation and treatment. The patient had a history of diabetes mellitus, treated with oral antidiabetic medication, and a history of thyroid surgery (thyroidectomy), requiring levothyroxine. No additional illnesses or medications were reported. Her family history was unremarkable. Physical examination showed normal respiratory sounds, with an oxygen saturation of 97% on room air, and other system examinations were within normal limits. Laboratory tests revealed an elevated serum angiotensin-converting enzyme (ACE) level of 93.9 U/L (reference range: 8\u0026ndash;52 U/L), while other blood tests, including calcium, were within normal limits.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThoracic computed tomography (CT) showed bilateral hilar and mediastinal lymph nodes. A convex probe endobronchial ultrasound (CP-EBUS) was performed, revealing multiple conglomerated lymph nodes in the right paratracheal and subcarinal areas, the largest being 25 mm in diameter, with three samples taken from each site. Cytological findings were reported as consistent with non-caseating granulomatous inflammation. The patient was followed up without medication for six years.\u003c/p\u003e\u003cp\u003eIn a follow-up thoracic CT, a nodule with irregular borders, 1 cm in diameter, was observed in the medial segment of the right middle lobe, along with secondary pleuroparenchymal changes in the basal segments of both lower lobes. A PET-CT scan showed newly detected lymph nodes with moderate to intense hypermetabolism in supradiaphragmatic and infradiaphragmatic lymph node stations, consistent with granulomatous disease. Splenic hypermetabolism was also observed. Given the elevated serum ACE level (140 U/mL), the patient was started on methylprednisolone 20 mg once daily in 2019.\u003c/p\u003e\u003cp\u003eDuring tapering, the patient developed dark-colored urine and hematuria, leading to referral to the urology clinic. Cystoscopy revealed raised mucosal lesions (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), and biopsy confirmed chronic non-caseating granulomatous inflammation. Corticosteroid treatment was continued. Three months later, follow-up cystoscopy showed partial regression of the lesions. Azathioprine 50 mg/day was added after rheumatology consultation, while methylprednisolone was maintained at 4 mg/day. The patient\u0026rsquo;s follow-up and treatment are ongoing.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSarcoidosis is a multisystem inflammatory disease characterized by the formation of non-caseating granulomas. The most common sites of involvement are the lungs and hilar lymph nodes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although many patients remain asymptomatic or require minimal therapy, sarcoidosis can affect almost any organ system. Genitourinary involvement, however, is rare (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBladder sarcoidosis is particularly uncommon and difficult to diagnose, as there are no specific laboratory or radiological markers (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In the literature, only a limited number of bladder sarcoidosis cases have been reported, often presenting with hematuria or irritative urinary symptoms. Our patient initially had no urological complaints, but later developed hematuria, leading to the diagnosis.\u003c/p\u003e\u003cp\u003eAs with other organ involvement, corticosteroids remain the mainstay of treatment. Immunosuppressive agents, such as azathioprine, may be considered in patients with relapsing or refractory disease. Bladder involvement should be carefully monitored, as it can lead to hydronephrosis or, rarely, be associated with metachronous bladder cancers (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDue to the lack of diagnostic tools beyond symptoms and histopathology, delayed diagnosis and underreporting of bladder sarcoidosis are possible. Therefore, clinicians should remain vigilant and include genitourinary evaluation in the follow-up of sarcoidosis patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBladder sarcoidosis is an extremely rare manifestation of sarcoidosis and should be considered in patients presenting with new urinary symptoms during follow-up. Early recognition and appropriate management may prevent complications and improve outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Written informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was waived due to the single-patient case report nature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, Y.İ.; methodology, Y.İ and E.\u0026Ccedil;.; software, Y.İ.; validation, Y.İ.,R.E.; formal analysis, Y.İ and E.\u0026Ccedil;.; investigation, Y.İ. and E.\u0026Ccedil;; resources, Y.İ.; data curation, Y.İ , R.E.; writing\u0026mdash;original draft preparation, Y.İ.; writing\u0026mdash;review and editing, Y.İ. and M.\u0026Ccedil;; visualization, M.\u0026Ccedil;; supervision, Y.İ.; project administration, Y.İ. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to institutional restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e-) Skopelidou V, Hurn\u0026iacute;k P, Židl\u0026iacute;k V, Tulinsk\u0026yacute; L, Lenz J, Balner T. Unnecessary orchiectomy due to atypical sarcoidosis manifesting as a unilateral scrotal mass: a case report and literature review. Front Immunol. 2023;14:1253120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fimmu.2023.1253120\u003c/span\u003e\u003cspan address=\"10.3389/fimmu.2023.1253120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 38090555; PMCID: PMC10711076.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-) Motswaledi MH, Khammissa RA, Jadwat Y, Lemmer J, Feller L. Oral sarcoidosis: a case report and review of the literature. Aust Dent J. 2014;59(3):389\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/adj.12196\u003c/span\u003e\u003cspan address=\"10.1111/adj.12196\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2014 Jul 30. PMID: 24862235.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-) Baughman RP, Valeyre D, Korsten P, Mathioudakis AG, Wuyts WA, Wells A et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J. 2021;58(6):2004079. doi: 10.1183/13993003.04079-2020. PMID: 34140301.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-) Kalia V, Vishal K, Gill JS, Gill A. Ureteric sarcoidosis\u0026ndash;a rare entity. Br J Radiol. 2010;83(996):e247\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1259/bjr/17908733\u003c/span\u003e\u003cspan address=\"10.1259/bjr/17908733\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 21088080; PMCID: PMC3473606.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-) Block NL, Kava BR. Genitourinary sarcoidosis: An essential review for the practicing clinician. Indian J Urol. 2017 Jan-Mar;33(1):6\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0970-1591.195724\u003c/span\u003e\u003cspan address=\"10.4103/0970-1591.195724\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 28197023; PMCID: PMC5264196.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sarcoidosis, Bladder, Hematuria, Case report","lastPublishedDoi":"10.21203/rs.3.rs-7607565/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7607565/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSarcoidosis is a chronic multisystem granulomatous disease most frequently involving the lungs and hilar lymph nodes. Genitourinary involvement, especially bladder sarcoidosis, is extremely rare.\u003c/p\u003e\u003ch2\u003eCase Presentation:\u003c/h2\u003e\u003cp\u003eWe report a 52-year-old female with a history of pulmonary sarcoidosis who later developed hematuria. Initial thoracic imaging and CP-EBUS revealed non-caseating granulomatous inflammation, consistent with sarcoidosis. After six years of follow-up, the patient developed urinary symptoms. Cystoscopy revealed raised bladder lesions, and biopsy confirmed chronic non-caseating granulomatous inflammation. The patient was treated with corticosteroids and later azathioprine was added due to persistent disease activity.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eBladder involvement in sarcoidosis is rare and often difficult to diagnose due to nonspecific findings. Careful monitoring of sarcoidosis patients, including assessment for urinary symptoms, is essential for early detection and timely management.\u003c/p\u003e","manuscriptTitle":"A rare cause of hematuria; a case report of sarcoidosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-12 02:19:38","doi":"10.21203/rs.3.rs-7607565/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-09T14:54:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309306284521315913396765262208474642538","date":"2025-11-09T14:27:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-30T20:53:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-07T22:41:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-03T09:36:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-03T09:36:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-09-13T13:03:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f077cba2-8811-44fa-8b68-7fcd0b754442","owner":[],"postedDate":"November 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-12T02:19:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-12 02:19:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7607565","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7607565","identity":"rs-7607565","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}