Current Opinion in Urology最新文献

{"title":"Standardizing outcomes in urethral stricture surgery: beyond anatomic patency.","authors":"Francesco Chierigo, Tommaso Saccucci, Guglielmo Mantica","doi":"10.1097/MOU.0000000000001404","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001404","url":null,"abstract":"<p><strong>Purpose of review: </strong>Outcome assessment after urethral stricture surgery remains inconsistent, with success traditionally defined by anatomical patency or absence of reintervention. Growing recognition of discordance between objective findings and patient experience has made it necessary to re-evaluate how outcomes are measured. This review explores contemporary approaches to defining success and highlights the need for standardized, patient-centered endpoints.</p><p><strong>Recent findings: </strong>Current literature shows that anatomical and objective functional measures alone fail to capture the complexity of postoperative recovery. Patient-reported outcome measures have gained increasing importance, revealing persistent urinary symptoms, sexual dysfunction, and quality-of-life impairment despite technically successful reconstruction. Functional outcomes such as storage symptoms, ejaculatory changes, and perceived penile alterations are increasingly recognized as key determinants of satisfaction. Emerging composite outcomes aim to integrate anatomical, functional, and patient-reported domains into a unified framework.</p><p><strong>Summary: </strong>Outcome evaluation in urethral stricture surgery is shifting toward multidimensional assessment that prioritizes patient perception alongside traditional metrics. Standardized composite endpoints may improve comparability across studies, support shared decision-making, and better align surgical success with patient expectations.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of urothelial carcinoma: a 2024-2025 update of early-phase trials of novel therapeutic agents.","authors":"Yan Hiu Athena Lee, Chris Ming-Ho Wong, Alex Qinyang Liu, Jeremy Yuen-Chun Teoh","doi":"10.1097/MOU.0000000000001388","DOIUrl":"10.1097/MOU.0000000000001388","url":null,"abstract":"<p><strong>Purpose of review: </strong>The treatment landscape for advanced and non-muscle-invasive urothelial carcinoma (UC) is rapidly evolving beyond platinum chemotherapy and immune checkpoint inhibitors. This review is timely and relevant as it synthesizes recent, impactful data from 2024-2025 early-phase trials, highlighting agents poised to redefine clinical standards.</p><p><strong>Recent findings: </strong>Recent studies showcase promising novel strategies. These include next-generation targeted therapies like sapanisertib, novel antibody-drug conjugates (ADCs) and bicycle toxin conjugates (BTCs) such as zelenectide pevedotin (BT8009) and dual-ADC combinations with high response rates, and the approved immunomodulator N-803 for BCG-unresponsive disease. Furthermore, innovative intravesical therapies, including ADCs (disitamab vedotin) and immune checkpoint inhibitors, show transformative potential for localized disease with favorable safety.</p><p><strong>Summary: </strong>The findings indicate a shift towards more effective and tailored treatments. Future efforts must focus on biomarker validation, strategic sequencing, and managing combination toxicities to integrate these advances into practice and improve patient outcomes.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"244-249"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burst wave lithotripsy: insights on effectiveness and safety.","authors":"Stamatios Katsimperis, Senol Tonyali, Lazaros Tzelves","doi":"10.1097/MOU.0000000000001380","DOIUrl":"10.1097/MOU.0000000000001380","url":null,"abstract":"<p><strong>Purpose of review: </strong>Burst wave lithotripsy (BWL) has emerged as a novel noninvasive approach for urinary stone management, aiming to overcome key limitations of conventional shock wave lithotripsy, including variable efficacy, pain, and tissue injury. This review examines the growing body of experimental and early clinical evidence evaluating BWL as a noninvasive, anesthesia-sparing option for urinary stone management.</p><p><strong>Recent findings: </strong>Recent experimental, preclinical, and first-in-human studies demonstrate that BWL can achieve efficient stone fragmentation across a range of compositions with controllable fragment size through frequency modulation. Clinical studies report high rates of stone comminution, favorable fragment profiles, and excellent tolerability in awake patients, with predominantly low-grade adverse events. Integration with ultrasonic propulsion has further improved fragment clearance and stone-free outcomes. Preclinical data also suggest a favorable renal safety profile, including in anticoagulated models.</p><p><strong>Summary: </strong>Current evidence supports BWL as a promising complementary technology for selected patients with renal and ureteral stones, offering truly noninvasive, patient-centered care. Ongoing trials will clarify its role within treatment algorithms and define optimal indications and workflows.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"272-277"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stone metrics: is stone volume the new king?","authors":"Charlotte Slots, Matthias Boeykens, Kim Pauwaert, Thomas Tailly","doi":"10.1097/MOU.0000000000001376","DOIUrl":"10.1097/MOU.0000000000001376","url":null,"abstract":"<p><strong>Purpose of review: </strong>Stone volume represents the most accurate measure of urolithiasis burden. While this may be obvious to all, this stone metric has not yet found its way into standard clinical practice or guidelines algorithms guiding treatment strategies. Although linear measurements have their obvious limitations, they are still most commonly used in practice and reported in literature as well as guidelines. This review evaluates the current available evidence supporting stone volume as the most important stone metric.</p><p><strong>Recent findings: </strong>By now, literature has been able to confidently demonstrate that stone volume is a more accurate predictor of stone free status in shockwave lithotripsy and ureteroscopy. Recent advances in three-dimensional imaging reconstruction, automated segmentation and artificial intelligence have lowered thresholds for obtaining stone volume from computed tomography imaging.</p><p><strong>Summary: </strong>Today, historical barriers have been overcome, and fast, reproducible stone volume assessment is at our fingertips. And yet, we do not use volume in our daily practice, as we ourselves hold back evolution. While future efforts should be put towards embracing volume as a stone metric, more studies are also needed to identify volume-based thresholds for treatment success aiding in the development of new treatment algorithms.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"278-282"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial introduction.","authors":"","doi":"10.1097/MOU.0000000000001385","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001385","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"36 3","pages":"v"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalised medicine in urothelial carcinoma: where do we stand and what is the way to go?","authors":"Amena Ahmad, Oskar Lepiarczyk, Alison J Birtle","doi":"10.1097/MOU.0000000000001387","DOIUrl":"10.1097/MOU.0000000000001387","url":null,"abstract":"<p><strong>Purpose of review: </strong>Personalised medicine has rapidly reshaped the management of urothelial carcinoma, driven by advances in tumour genomics, immune profiling and targeted drug development. This review is timely as multiple biomarker-driven therapies have recently entered routine clinical practice across disease stages, necessitating an integrated appraisal of how precision approaches should be applied and sequenced in contemporary care.</p><p><strong>Recent findings: </strong>Key advances include the expanding role of immune biomarkers beyond PD-L1, such as tumour mutational burden and DNA damage response alterations, to refine the use of immune checkpoint inhibitors. FGFR3 alterations represent the first validated genomic target in urothelial carcinoma, with FGFR inhibitors now established treatment options. Antibody-drug conjugates targeting Nectin-4 and HER2 have demonstrated substantial clinical activity, redefining treatment paradigms in both first-line and refractory settings. In parallel, circulating tumour DNA has emerged as a powerful dynamic biomarker for minimal residual disease detection and adjuvant treatment selection.</p><p><strong>Summary: </strong>Urothelial carcinoma has transitioned into a biomarker-driven disease, enabling more precise, biologically informed treatment decisions. Integrating genomic, immunologic and liquid biopsy biomarkers will be essential to optimise patient selection, treatment sequencing and toxicity management, and represents a critical direction for future research and clinical practice.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"250-256"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stone fragmentation in percutaneous surgery: is there a paradigm shift?","authors":"Stefano Schininà, Attilio Barretta, Riccardo Schiavina, Vincent De Coninck","doi":"10.1097/MOU.0000000000001379","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001379","url":null,"abstract":"<p><strong>Purpose of review: </strong>Percutaneous nephrolithotomy (PCNL) remains the gold standard for the treatment of large and complex renal calculi. Traditionally, stone fragmentation during PCNL has relied on mechanical lithotripsy combined with manual or passive fragment extraction. This review examines whether recent advances in stone fragmentation and evacuation technologies represent a true paradigm shift in percutaneous stone surgery or rather a progressive refinement of established principles.</p><p><strong>Recent findings: </strong>Recent literature highlights a progressive transition from conventional mechanical lithotripsy - based on ultrasonic, pneumatic, or dual-energy devices - towards laser-based fragmentation strategies, particularly in miniaturized PCNL. While mechanical systems remain highly effective in standard-tract PCNL, their efficiency and applicability may be limited as access calibre decreases. In this setting, holmium:YAG and thulium fibre lasers, supported by advanced pulse modulation technologies, enable efficient dust-oriented fragmentation through small-calibre tracts. The parallel introduction of suction-enabled access sheaths has further modified clearance dynamics, allowing simultaneous fragmentation and active evacuation. Comparative studies consistently report comparable stone-free rates (SFRs) between traditional and contemporary approaches, with improvements in operative efficiency, intrarenal pressure control, and procedural workflow favouring laser-based and suction-assisted systems.</p><p><strong>Summary: </strong>Overall, current evidence supports a shift in PCNL from mechanical fragmentation and fragment extraction towards laser-driven dusting combined with active aspiration. This evolution appears to prioritize efficiency and physiological safety rather than absolute gains in stone-free rates. However, its broader adoption remains dependent on cost, equipment availability, and training, underscoring the need for further comparative and implementation-focused research.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"36 3","pages":"295-300"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating bladder preservation in Bacillus Calmette-Guérin-unresponsive disease: how much risk is too much?","authors":"Alfredo Aliaga, Cristóbal Ávila, Mario I Fernández","doi":"10.1097/MOU.0000000000001371","DOIUrl":"10.1097/MOU.0000000000001371","url":null,"abstract":"<p><strong>Purpose of review: </strong>Management of Bacillus Calmette-Guérin-unresponsive non-muscle-invasive bladder cancer (BCG-unresponsive NMIBC) is rapidly evolving, with an expanding range of bladder-sparing therapies challenging the traditional paradigm of early radical cystectomy. This review is timely given the growing need to balance oncologic safety with quality-of-life considerations in patients who are unfit for or unwilling to undergo cystectomy.</p><p><strong>Recent findings: </strong>Recent studies have demonstrated clinically meaningful response rates with several bladder-sparing strategies, including intravesical chemotherapy combinations, gene therapy, immune-modulating agents, and systemic immunotherapy. Although durability varies and cross-trial comparisons are limited, emerging data suggest that, in carefully selected patients, an initial bladder-sparing approach followed by timely salvage cystectomy - if required - may achieve oncologic outcomes comparable to upfront cystectomy, provided progression to muscle-invasive disease is avoided.</p><p><strong>Summary: </strong>Bladder preservation in BCG-unresponsive NMIBC should be framed as a preference-sensitive decision that integrates individual progression risk, feasibility of delayed cystectomy, and patient-valued functional outcomes. Rather than a fixed threshold, acceptable oncologic risk represents a negotiated balance, with the urologist acting as a navigator who defines safety boundaries while supporting informed, patient-centered decision-making.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"235-243"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in laser pulse modulations.","authors":"Daniele Robesti, Davide Perri, Giorgio Bozzini, Ioannis Kartalas Goumas, Eugenio Ventimiglia","doi":"10.1097/MOU.0000000000001381","DOIUrl":"10.1097/MOU.0000000000001381","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes the most recent evidence evaluating the clinical impact of pulse modulation technologies in endourology, with a specific focus on laser lithotripsy and endoscopic prostate enucleation.</p><p><strong>Recent findings: </strong>Pulse modulation alters laser-fluid-target interaction by influencing cavitation bubble dynamics, optical shielding, and momentum transfer. Advanced pulse-shaping strategies, including split-pulse delivery (e.g. Moses Technology, Virtual Basket), extended vapor-channel pulses, controlled cavitation systems, and very low peak power modulation (e.g. Magneto Technology), have demonstrated improved energy coupling, reduced retropulsion, and enhanced procedural performance in preclinical models. In laser lithotripsy, evidence spans in vitro experiments, prospective cohorts, retrospective comparisons, and one randomized controlled trial. While preclinical data consistently support improved fragmentation efficiency and retropulsion control, clinical studies report comparable stone-free rates between pulse-modulated holmium:yttrium-aluminum-garnet (Ho:YAG), conventional Ho:YAG, and thulium fiber lasers, with modest advantages in operative efficiency and energy consumption. In prostate enucleation, available data are mostly limited to nonrandomized studies, suggesting improved hemostasis and procedural efficiency without clear benefits in functional outcomes.</p><p><strong>Summary: </strong>Pulse modulation improves laser handling and efficiency, but its superiority in hard clinical outcomes remains unproven.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"257-265"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latest developments in urinary tumor DNA and its current clinical role in urothelial bladder cancer and upper tract urothelial carcinoma.","authors":"Daniel A González-Padilla, José Daniel Subiela, Félix Guerrero-Ramos, Renate Pichler, Daniel Sánchez-Zalabardo, Felipe Villacampa-Auba","doi":"10.1097/MOU.0000000000001373","DOIUrl":"10.1097/MOU.0000000000001373","url":null,"abstract":"<p><strong>Purpose of review: </strong>Urinary tumor DNA (utDNA) has emerged as a promising noninvasive biomarker that may complement or reduce the need for cystoscopies in the diagnosis, surveillance, and treatment monitoring of urothelial carcinoma. Unlike plasma circulating tumor DNA (ctDNA), which is heavily diluted by hematopoietic cell-derived DNA, utDNA originates directly from tumor cell shedding into urine and often appears at higher concentrations, improving molecular detection. While there is an increasing number of publications using utDNA with promising results, most of these studies were developed from a laboratory perspective, making it difficult to find a direct clinical application. This review aims to apply a clinical perspective for potential daily practice use of utDNA testing.</p><p><strong>Recent findings: </strong>This review summarizes the most recent literature on the potential clinical use of utDNA for diagnosis, follow-up, and response to treatment in nonmuscle-invasive bladder cancer, muscle-invasive bladder cancer, and upper tract urothelial carcinoma.</p><p><strong>Summary: </strong>There is accumulating evidence on the potential use of utDNA for the diagnosis of urothelial carcinoma in the bladder as well as in the upper tract, while preliminary studies show promising results with sensitivities around 80-90% and specificities 90-100%, further research is needed.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"219-226"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}