Current Opinion in Urology最新文献

{"title":"Oncolytic virus therapy for nonmuscle-invasive bladder cancer: current status and future directions.","authors":"Hiroshi Kitamura, Naotaka Nishiyama","doi":"10.1097/MOU.0000000000001331","DOIUrl":"10.1097/MOU.0000000000001331","url":null,"abstract":"<p><strong>Purpose of review: </strong>Nonmuscle-invasive bladder cancer (NMIBC) patients with BCG-unresponsive disease have limited treatment options beyond radical cystectomy. With ongoing BCG shortages and the urgent need for bladder-preserving alternatives, this review examines the emerging role of oncolytic virus therapy as a novel intravesical treatment approach for this challenging patient population.</p><p><strong>Recent findings: </strong>Multiple oncolytic viral platforms have entered clinical trials for NMIBC treatment, demonstrating promising efficacy and safety profiles. Cretostimogene grenadenorepvec has shown exceptional results in a phase 3 trial, achieving 74.5% complete response rates with durable responses exceeding 27 months in BCG-unresponsive carcinoma in situ. Combination therapy with pembrolizumab further enhanced efficacy, with a 57.1% complete response rate at 12 months and no progression to muscle-invasive disease. Other viral platforms, including herpes simplex, coxsackie, and measles viruses, have demonstrated preliminary antitumor activity with favorable safety profiles. These agents utilize three mechanisms of action: selective viral replication, direct oncolysis, and immune system activation.</p><p><strong>Summary: </strong>Oncolytic virus therapy represents a paradigm shift toward an effective bladder-preserving treatment for BCG-unresponsive NMIBC. With phase 3 data supporting regulatory approval pathways, these therapies are poised to become new standards of care, offering hope for improved outcomes while avoiding radical surgery.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"629-635"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023112","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":"Harmonizing environmental and economic forces in urologic care.","authors":"Maximilian J Rabil, Ankur U Choksi, Michael S Leapman","doi":"10.1097/MOU.0000000000001338","DOIUrl":"10.1097/MOU.0000000000001338","url":null,"abstract":"<p><strong>Purpose of review: </strong>Increases in wealth, scientific knowledge, and resources have contributed to unprecedented improvements in overall and urologic health over the past century. However, anthropogenic greenhouse gas emissions driving these advancements are a primary driver of climate change, including a substantial share contributed from the healthcare industry itself. Reducing resource-intensive processes in urologic care has been proposed to support environmental sustainability but these initiatives could conflict with economic forces that drive progress in biomedical innovation. Paradoxically, such strategies may also have unintended consequences for human health by slowing the pipeline or scientific discovery or delivery of treatment. A balanced approach can prioritize the elimination of low-value services in order to enhance care value while simultaneously reducing environmental waste and resource consumption. In this review, we examine strategies that seek to align environmental and economic forces in urologic care delivery within a market-influenced healthcare system.</p><p><strong>Recent findings: </strong>Strategies to reduce low-value urologic care, including decreased reliance on single-use items, reducing use of the operating room when feasible, and judicious use of resource-intensive research methods, have potentially favorable environmental impacts. A maturing body of research has examined ways in which reductions in low-value services can be incorporated into clinical practice without compromising quality, safety, and patient outcomes.</p><p><strong>Summary: </strong>Sustainability efforts in urology can be aligned with economic realities to be effective and scalable. Strategies that reduce environmental impact should consider cost, local market, and incentives within existing healthcare systems. Aligning ecological responsibility with economic value ensures that sustainable practices can be adopted without slowing clinical progress.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"679-684"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063789","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":"Novel intravesical delivery systems for nonmuscle invasive bladder cancer.","authors":"Alessandro Uleri, Olga Katzendorn, Zine Eddine Khene, Evanguelos Xylinas, Felix-Guerrero Ramos, Benjamin Pradere","doi":"10.1097/MOU.0000000000001326","DOIUrl":"10.1097/MOU.0000000000001326","url":null,"abstract":"<p><strong>Purpose of review: </strong>Nonmuscle invasive bladder cancer (NMIBC) represents approximately 75% of bladder cancer cases at diagnosis and poses a significant management challenge due to high recurrence rates and risk for progression. Conventional intravesical therapies face limitations including suboptimal drug delivery, mucosal exposure time and significant adverse events. This review provides a timely assessment of novel intravesical delivery systems developed to overcome these limitations and improve oncological outcomes for patients with NMIBC.</p><p><strong>Recent findings: </strong>Several innovative delivery systems show promising results. Hyperthermic intravesical chemotherapy (HIVEC) demonstrates its efficacy in selected high-risk NMIBC. Intravesical drug-releasing systems (iDRS) like TAR-200 showed complete response rates up to 84% in BCG-unresponsive disease, while TAR-210 shows promise for FGFR-altered NMIBC. UGN-102, a reverse thermal gel containing mitomycin C, achieves 65-79% complete response rates in low-grade intermediate-risk NMIBC. Oncofid-P-B, combining paclitaxel with hyaluronic acid, demonstrates efficacy in BCG-unresponsive CIS.</p><p><strong>Summary: </strong>Novel intravesical delivery systems show to enhance drug retention, improve tissue penetration, and potentially reduce adverse events. While traditional chemotherapy or BCG remain the gold-standard adjuvant treatments for NMIBC, these novel approaches offer promising alternatives for selected patients pending on ongoing clinical validation.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"645-652"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648803","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":"Hyperthermic intravesical chemotherapy for Bacillus Calmette-Guérin-unresponsive nonmuscle-invasive bladder cancer.","authors":"Félix Guerrero-Ramos, Carmen Gómez-Cañizo, Mario Hernández-Arroyo, José Daniel Subiela, Benjamin Pradere, Evangelos Xylinas, Alfredo Rodríguez-Antolín","doi":"10.1097/MOU.0000000000001329","DOIUrl":"10.1097/MOU.0000000000001329","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hyperthermic intravesical chemotherapy (HIVEC) and other device-assisted platforms are emerging bladder-sparing options after Bacillus Calmette-Guérin (BCG) failure in nonmuscle-invasive bladder cancer (NMIBC). This review integrates recent mechanistic, clinical and economic evidence to clarify their therapeutic position.</p><p><strong>Recent findings: </strong>Prospective and real-world series in BCG-unresponsive disease report complete response rates of 40-60% for carcinoma in situ and 35-70% 12-24-month high-grade recurrence-free survival for papillary tumors. Radiofrequency-induced thermo-chemotherapy, recirculant chemohyperthermia and electromotive drug administration achieve comparable efficacy. Toxicity is usually grade 1-2 urinary urgency, frequency or dysuria, with serious events in fewer than 10% of patients. Health-economic modelling suggests HIVEC becomes cost-effective once high-grade recurrence-free survival exceeds 30% at 12 months.</p><p><strong>Summary: </strong>Device-assisted hyperthermic chemotherapy combines biological plausibility, acceptable safety and favorable cost, positioning it as a potential option between BCG failure and radical cystectomy. Ongoing phase III trials will determine long-term oncological control, refine patient selection and optimize sequencing with systemic and intravesical agents.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"620-628"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854876","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":"Systemic immunotherapy for BCG unresponsive nonmuscle-invasive bladder cancer.","authors":"Karima Oualla, Mehdi Alem, Jeremy Teoh","doi":"10.1097/MOU.0000000000001334","DOIUrl":"10.1097/MOU.0000000000001334","url":null,"abstract":"<p><strong>Purpose of review: </strong>Treatment of Bacillus Calmette-Guérin (BCG)-refractory nonmuscle-invasive bladder cancer (NMIBC) is a significant clinical problem, with limited bladder-sparing strategies. The following review aims to show the recent advances in systemic immunotherapy that are transforming the treatment paradigm in patients with BCG-refractory NMIBC.</p><p><strong>Recent findings: </strong>Developing evidence highlights the therapeutic success of immune checkpoint inhibitors, such as pembrolizumab and gene therapy, which received regulatory approval for high-risk BCG-refractory NMIBC. Combination regimens, with immunotherapy combined with intravesical therapy or chemotherapy, are under exploration to enhance treatment efficacy and bypass resistance. The identification of new molecular targets and the development of tailored strategies also depict the fast-paced evolution in this field.</p><p><strong>Summary: </strong>Systemic immunotherapy is now of potential benefit in BCG-refractory NMIBC patients, providing viable bladder-sparing therapies. Our findings have significant implications for clinical practice and enable the transition to individualized, less invasive therapies. More work is required to optimize outcomes, expand therapeutic options, and improve quality of life in this challenging patient population.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"636-644"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063797","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":"Surgical management of benign prostatic hyperplasia in elderly and frail patients: a narrative review.","authors":"Julien Anract, Clément Klein, Ugo Pinar, Jérôme Gas, Jonas Wilisch, Souhil Lebdai","doi":"10.1097/MOU.0000000000001336","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001336","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this review was to evaluate the outcomes of the various surgical techniques available today, focusing on their applicability to frail and/or elderly patients.</p><p><strong>Recent findings: </strong>Transurethral resection of prostate (TURP) allowed a reduction of hemorrhagic complications compared to open simple prostatectomy. However, laser surgery show the best safety profile among the standards techniques. Importantly, most of studies demonstrate no difference in efficacy of LUTS management in frail or elderly population compared to younger patients. Recently, mini invasive surgical therapies (MIST) emerged, allowing a reduction in complication and a potential feasibility under general anesthesia. Prostatic artery embolization (PAE) showed longer procedures but equivalent efficacy compared to younger population. Data remains scarce regarding prostatic uretral lift (PUL) and water vapor thermal therapy (WVT), but studies suggest promising results, particularly for trial without catheter at 12 months for elderly population.</p><p><strong>Summary: </strong>In frail and elderly patients, laser surgery significantly reduces the hemorrhagic complications compared to traditional techniques. In addition, laser surgery shows equivalent efficacy in elderly and young population, reinforcing the indication of laser in elderly when feasible. The option of MISTs is rising, but validation is needed with further studies.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085415","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":"Does the existing evidence on flexible and navigable suction ureteral access sheath indicate a potential paradigm shift in the management of kidney and ureteral stones with flexible ureteroscopy? An overview from EAU endourology.","authors":"Vineet Gauhar, Daniele Castellani, Arman Tsaturyan, Kazumi Taguchi, Thomas Herrmann, Bhaskar Somani, Steffi Kar Kei Yuen","doi":"10.1097/MOU.0000000000001333","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001333","url":null,"abstract":"<p><strong>Purpose of review: </strong>This opinion article from the EAU Endourology Section critically summarizes the existing evidence on flexible and navigable suction ureteral access sheaths (FANS) to determine if they represent a paradigm shift in managing kidney and ureteral stones with flexible ureteroscopy (FURS). This scoping review aims to synthesize recent findings on FANS efficacy, safety, and potential to overcome limitations of conventional ureteral access sheath (C-UAS) and other modalities.</p><p><strong>Recent findings: </strong>Current evidence demonstrates FANS significantly outperforms C-UAS. Key findings include substantially higher immediate and 30-day stone-free rates (SFR), including achievable zero-fragment status, even for stones >2 cm, multiple stones, lower pole stones, and in paediatric patients. FANS reduces infectious complications (e.g., postoperative fever and sepsis), improves intrarenal pressure control, minimizes radiation exposure risk, and shortens operative times. Studies show noninferiority to mini-PCNL for 2-3 cm stones, with advantages like better quality of life and reduced bleeding. FANS enables same-session bilateral procedures and may reduce the need for postoperative stenting. Surgeons report high satisfaction due to improved visualization, suction efficiency, and navigation.</p><p><strong>Summary: </strong>The collective evidence from this review positions FANS as a transformative technology enabling a paradigm shift in FURS for both adults and children. By enhancing stone clearance, visualization, and efficiency while reducing infectious complications through superior IRP control and expanding applicability to complex cases, FANS overcomes key limitations of conventional approaches. As the technology evolves, FANS is established as essential for achieving optimal SFR in FURS, fundamentally changing urolithiasis management.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023017","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":"Next-gen minimally invasive surgical therapies for benign prostatic hyperplasia: innovations, selection, and best practices- a review from European Association of Urology endourology.","authors":"Keiran J C Pace, Tiange Li, Dean S Elterman","doi":"10.1097/MOU.0000000000001335","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001335","url":null,"abstract":"<p><strong>Purpose of review: </strong>The expanding range of minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia (BPH) reflects a growing emphasis on individualized, anatomy-driven treatment that prioritizes symptom relief, reduced morbidity, and preservation of sexual function. This review provides a timely synthesis of MISTs, highlighting innovations in technique, key anatomical considerations, and evolving strategies for patient-centered care in the modern clinical setting.</p><p><strong>Recent findings: </strong>Recent studies highlight the expanding role of MISTs, such as UroLift, Rezūm, the temporary implanted nitinol device, Optilume BPH, transperineal laser ablation, and prostatic stents. Each modality shows distinct performance characteristics depending on factors such as prostate volume, intravesical prostatic protrusion, bladder neck configuration, and the presence of a median lobe. Increasing attention has also been given to preserving antegrade ejaculation, which is often a high priority for younger or sexually active patients. Concurrently, new decision aid tools are in development to support shared decision-making in concordance with patient values and treatment preferences.</p><p><strong>Summary: </strong>MISTs represent a diverse and maturing set of therapeutic options. Optimizing their use requires detailed anatomical assessment and thoughtful, individualized decision-making to align treatment with patient goals, preserve function, minimize morbidity, and reflect contemporary evidence-based standards in BPH management.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023064","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":"Integration of prostate-specific membrane antigen-PET and multiparametric MRI for gross tumour volume definition in localised and locally advanced prostate cancer treated with image-guided radiotherapy.","authors":"Tessa D van Bergen, Arthur J A T Braat, Cornelis A T van den Berg, Timo F W Soeterik","doi":"10.1097/MOU.0000000000001321","DOIUrl":"10.1097/MOU.0000000000001321","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review evaluates recent evidence on the utility of multiparametric MRI (mpMRI), prostate-specific membrane antigen (PSMA) PET, and their combined application for accurately delineating the intraprostatic gross tumour volume (GTV) in patients with primary localised and locally advanced prostate cancer. It further explores the impact of GTV-based dose escalation on treatment-related toxicity and clinical outcomes.</p><p><strong>Recent findings: </strong>Recent studies suggest that combining PSMA-PET with mpMRI enhances lesion coverage of clinically significant, histopathologically verified intraprostatic tumours and yields higher interobserver agreement. However, this improved sensitivity is offset by reduced specificity, and it remains uncertain whether expanding the GTV to include additional PSMA-PET-defined regions impacts long-term treatment-related toxicity or improves oncological outcomes. Multiple phase I/II trials using PSMA-PET and mpMRI have reported acceptable acute and late toxicity profiles. Nevertheless, extensive data on long-term toxicity and disease outcomes following PSMA-PET-guided interventions remain limited, warranting further investigation to assess its impact.</p><p><strong>Summary: </strong>The combination of mpMRI and PSMA-PET has been shown to improve coverage of dominant intraprostatic lesion and reduce interobserver variability. While GTVs derived from combined imaging modalities are typically larger than those based on mpMRI alone, hypofractionated focal boost treatments targeting PSMA-PET/mpMRI-defined GTVs have demonstrated acceptable acute toxicity profiles. More data are needed to determine the impact of PSMA-PET expanded GTVs on long-term clinical outcomes.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"554-561"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642051","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":"VISION, TheraP, LuTectomy and beyond - is there a role for lutetium therapy in biochemical recurrence?","authors":"David Hennes, Jasmin Weindler, Christa Babst, Marlon L Perera, Declan G Murphy, Renu S Eapen","doi":"10.1097/MOU.0000000000001323","DOIUrl":"10.1097/MOU.0000000000001323","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review synthesizes current evidence and recommendations for the use of lutetium-177 prostate-specific membrane antigen (LuPSMA) radioligand therapy across the spectrum of prostate cancer, focusing on its established use in metastatic castration-resistant prostate cancer (mCRPC), and evolving role in metastatic hormone-sensitive disease (mHSPC) and in neoadjuvant treatment of high-risk localized disease. We explore the potential for its use in biochemical recurrence (BCR) highlighting its limitations, and areas for future research.</p><p><strong>Recent findings: </strong>LuPSMA has demonstrated oncological efficacy and tolerability over standard of care treatments in mCRPC, supported by landmark trials such as VISION, TheraP, and PSMAfore. In mHSPC, the UpFront PSMA and PSMAddition trials have demonstrated promising improvements in undetectable PSA rates and progression-free survival when LuPSMA was combined with standard therapies. Furthermore, the LuTectomy trial has shown that neoadjuvant LuPSMA prior to radical prostatectomy in high risk localised prostate cancer can deliver high but variable doses of targeted radiation to PSMA expressing cells, and is surgically safe and tolerated well.</p><p><strong>Summary: </strong>LuPSMA radioligand therapy is a form of targeted therapy that has been shown to improve outcomes and quality of life in advanced disease with limited toxicity. While its use is well established in mCRPC, ongoing trials are exploring its efficacy in earlier disease stages and in combination with other therapies. Continued research and guideline development are essential to optimize LuPSMA's application across the prostate cancer disease spectrum, particularly in the BCR setting.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"527-534"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682197","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}