Current Opinion in Urology最新文献

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Oncolytic virus therapy for nonmuscle-invasive bladder cancer: current status and future directions. 溶瘤病毒治疗非肌肉浸润性膀胱癌:现状和未来方向。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-11-01 Epub Date: 2025-09-05 DOI: 10.1097/MOU.0000000000001331
Hiroshi Kitamura, Naotaka Nishiyama
{"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}
引用次数: 0
Harmonizing environmental and economic forces in urologic care. 协调泌尿科护理中的环境和经济力量。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-11-01 Epub Date: 2025-09-12 DOI: 10.1097/MOU.0000000000001338
Maximilian J Rabil, Ankur U Choksi, Michael S Leapman
{"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}
引用次数: 0
Novel intravesical delivery systems for nonmuscle invasive bladder cancer. 新型膀胱内给药系统治疗非肌肉浸润性膀胱癌。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-11-01 Epub Date: 2025-07-16 DOI: 10.1097/MOU.0000000000001326
Alessandro Uleri, Olga Katzendorn, Zine Eddine Khene, Evanguelos Xylinas, Felix-Guerrero Ramos, Benjamin Pradere
{"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}
引用次数: 0
Hyperthermic intravesical chemotherapy for Bacillus Calmette-Guérin-unresponsive nonmuscle-invasive bladder cancer. 卡尔梅芽孢杆菌-谷氨酰胺-无反应的非肌肉浸润性膀胱癌的膀胱内热化疗。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-11-01 Epub Date: 2025-08-13 DOI: 10.1097/MOU.0000000000001329
Félix Guerrero-Ramos, Carmen Gómez-Cañizo, Mario Hernández-Arroyo, José Daniel Subiela, Benjamin Pradere, Evangelos Xylinas, Alfredo Rodríguez-Antolín
{"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}
引用次数: 0
Systemic immunotherapy for BCG unresponsive nonmuscle-invasive bladder cancer. 卡介苗无应答的非肌肉浸润性膀胱癌的全身免疫治疗。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-11-01 Epub Date: 2025-09-12 DOI: 10.1097/MOU.0000000000001334
Karima Oualla, Mehdi Alem, Jeremy Teoh
{"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}
引用次数: 0
Testicular germ cell tumors and molecular biomarkers. 睾丸生殖细胞肿瘤及分子生物标志物。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-10-23 DOI: 10.1097/MOU.0000000000001353
Bruno Oliveira-Lopes, Nuno Tiago Tavares, João Lobo
{"title":"Testicular germ cell tumors and molecular biomarkers.","authors":"Bruno Oliveira-Lopes, Nuno Tiago Tavares, João Lobo","doi":"10.1097/MOU.0000000000001353","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001353","url":null,"abstract":"<p><strong>Purpose of review: </strong>Testicular germ cell tumors (TGCTs) are the most common neoplasms in young-adult males. Despite their good prognosis and high curability, some challenges remain, namely: overtreatment, discrimination of teratoma, prediction of relapse and cisplatin resistance. Novel molecular biomarkers are being tested for future clinical implementation.</p><p><strong>Recent findings: </strong>MicroRNAs (miRNAs) are the most promising approach for noninvasive diagnosis of TGCTs. MiR-371a-3p has shown high sensitivity and specificity in many studies with different approaches and is in line to enter clinical routine soon. Novel immunohistochemistry (IHC) biomarkers like FOXA2 have been advanced for yolk sac tumor diagnosis. Circulating tumor DNA (ctDNA) levels for minimal residual disease (MRD) detection constitutes a promising test in the field.</p><p><strong>Summary: </strong>Further studies on additional noninvasive biomarkers with high sensitivity are necessary. In this setting, miR-371a-3p remains the most promising biomarker, approaching clinical implementation soon. Other promising approaches are being studied but to date with significantly less accuracy than miR-371a-3p. Future studies on liquid biopsies should focus on the detection of teratoma and prediction of relapse, with the field of miRNAs and ctDNA being the most promising.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145344104","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}
引用次数: 0
Side effect management and procedural best practices with indwelling intravesical drug-releasing systems in the treatment of bladder cancer: recommendations from expert panels. 膀胱内留置药物释放系统治疗膀胱癌的副作用管理和程序最佳实践:专家小组的建议。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-10-08 DOI: 10.1097/MOU.0000000000001350
Benjamin Pradere, Maarten Schuit, Félix Guerrero-Ramos, Shahrokh F Shariat, Hiroshi Kitamura, Joseph M Jacob, Yige Bao, John Heesakkers, Kenneth M Peters, David J Cahn, Bart De Troyer, Bernardo Herrera Imbroda, David S Morris, Christopher M Pieczonka, Qiang Wei, Sumeet Bhanvadia, Robert Somer, Wolfgang Jessner, Spyros Triantos, Cristina Sánchez de Llano, John C Maffeo, Hussein Sweiti, Sarah P Psutka
{"title":"Side effect management and procedural best practices with indwelling intravesical drug-releasing systems in the treatment of bladder cancer: recommendations from expert panels.","authors":"Benjamin Pradere, Maarten Schuit, Félix Guerrero-Ramos, Shahrokh F Shariat, Hiroshi Kitamura, Joseph M Jacob, Yige Bao, John Heesakkers, Kenneth M Peters, David J Cahn, Bart De Troyer, Bernardo Herrera Imbroda, David S Morris, Christopher M Pieczonka, Qiang Wei, Sumeet Bhanvadia, Robert Somer, Wolfgang Jessner, Spyros Triantos, Cristina Sánchez de Llano, John C Maffeo, Hussein Sweiti, Sarah P Psutka","doi":"10.1097/MOU.0000000000001350","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001350","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide expert recommendations for side effect management in patients with bladder cancer receiving intravesical-drug releasing system (iDRS) treatment and for optimizing iDRS insertion procedure success.</p><p><strong>Recent findings: </strong>Indwelling iDRS are designed to provide sustained local exposure to therapy. In clinical trials, frequent side effects of iDRS treatment were lower urinary tract symptoms (LUTS) (e.g., dysuria, pollakiuria, micturition urgency), urinary tract infections (UTIs), and hematuria. These side effects are generally low grade, but if not properly managed, may lead to treatment interruptions or discontinuations. As data are limited, practical recommendations based on expert opinion for the management of common side effects and best practices for iDRS insertion procedures may improve treatment adherence and optimize outcomes in patients with bladder cancer receiving iDRS.</p><p><strong>Summary: </strong>Two separate expert panels were convened to develop recommendations for side effect management with iDRS and optimizing iDRS insertion procedure success. Stepwise treatment-specific management strategies for LUTS, UTIs, and hematuria in patients receiving iDRS treatment that are familiar to practicing urologists are presented, including considerations for continuation or discontinuation of iDRS treatment. Several advanced techniques can be considered to improve iDRS insertions based on variations in patient anatomy.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250371","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}
引用次数: 0
Rethinking thermal safety in laser lithotripsy: a systematic review of thermal dose thresholds. 对激光碎石热安全性的再思考:热剂量阈值的系统回顾。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-10-07 DOI: 10.1097/MOU.0000000000001346
Felipe Pauchard, Alejandro Calvillo-Ramirez, Jose A Salvadó, Olivier Traxer, Eugenio Ventimiglia
{"title":"Rethinking thermal safety in laser lithotripsy: a systematic review of thermal dose thresholds.","authors":"Felipe Pauchard, Alejandro Calvillo-Ramirez, Jose A Salvadó, Olivier Traxer, Eugenio Ventimiglia","doi":"10.1097/MOU.0000000000001346","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001346","url":null,"abstract":"<p><strong>Purpose of review: </strong>To perform a systematic review of cumulative equivalent minutes at 43 °C (CEM43) threshold considered by endourology literature to induce tissue thermal damage.</p><p><strong>Recent findings: </strong>While empirical strategies to reduce temperature have been suggested, the concept of thermal dose provides a more accurate framework to assess thermal injury, as it integrates both temperature and exposure duration.</p><p><strong>Summary: </strong>A systematic review was performed in accordance with PRISMA checklist regarding thermal dose and laser lithotripsy. Eight hundred and fifty-seven articles were identified, and 19 were considered for final analysis. All of them based the thermal dose calculation on the model by Sapareto and Dewey. The most common threshold used was CEM43 at least 120 min. However, this value has not been empirically validated for renal tissue and may significantly overestimate its thermal tolerance. Evidence suggests that renal thermal damage can occur at CEM43 values as low as 20-70 min. The thermal dose concept allows to understand the profile of temperature that might be safe. The classical thresholds proposed in endourology papers seems to be well above the actual tolerance of renal tissue. Caution should be taken with laser settings to avoid potential cell injury due to overheating during laser lithotripsy.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244002","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}
引用次数: 0
Cribriform carcinoma of the prostate, as aggressive as it sounds? A narrative review from the EAU section of endourology. 筛状前列腺癌,听起来很严重吗?一篇来自EAU泌尿科的叙述性综述。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-10-07 DOI: 10.1097/MOU.0000000000001347
Nour Khalil, Guiseppe Maiolino, Massimo Valerio, Eric Barret
{"title":"Cribriform carcinoma of the prostate, as aggressive as it sounds? A narrative review from the EAU section of endourology.","authors":"Nour Khalil, Guiseppe Maiolino, Massimo Valerio, Eric Barret","doi":"10.1097/MOU.0000000000001347","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001347","url":null,"abstract":"<p><strong>Purpose of review: </strong>The management of localized prostate cancer (PCa) is shifting towards tissue-preserving strategies such as active surveillance and focal therapies. Intermediate-risk PCa, especially ISUP Grade Group 2 (GG2), encompasses a heterogeneous disease spectrum, complicating patient selection for conservative treatments. Cribriform architecture, a Gleason pattern 4 subtype, is associated with poorer outcomes and currently contraindicates active surveillance However, these conclusions are mainly based on retrospective data from older cohorts, raising questions about cribriform's independent prognostic value versus Gleason pattern 4 burden.</p><p><strong>Recent findings: </strong>Cribriform pattern correlates strongly with increased Gleason pattern 4, which is linked to adverse features such as biochemical recurrence and tumour upstaging. The independent impact of cribriform remains unclear due to limited regression analyses and variable reporting. Cribriform detection on biopsy and MRI is challenging, often leading to underestimation and complicating risk stratification.</p><p><strong>Summary: </strong>Despite current guidelines excluding cribriform-positive patients from active surveillance, emerging evidence suggests some patients with limited cribriform and low Gleason 4 percentage could be candidates for active surveillance or focal therapies. Prospective studies with standardized cribriform quantification and imaging evaluation are needed to clarify these issues.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243989","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}
引用次数: 0
Demystifying machine learning in endourology - understanding models, applications, and clinical impact: a review from EAU endourology. 揭开机器学习在泌尿道学中的神秘面纱——理解模型、应用和临床影响:来自EAU泌尿道学的综述。
IF 2.2 3区 医学
Current Opinion in Urology Pub Date : 2025-09-25 DOI: 10.1097/MOU.0000000000001348
Chady Ghnatios, Rose Mary Attieh, Frederic Panthier
{"title":"Demystifying machine learning in endourology - understanding models, applications, and clinical impact: a review from EAU endourology.","authors":"Chady Ghnatios, Rose Mary Attieh, Frederic Panthier","doi":"10.1097/MOU.0000000000001348","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001348","url":null,"abstract":"<p><strong>Purpose of review: </strong>Machine learning algorithms are occupying a larger space in medical and urology applications. However, typical medical physicians are not trained on these technologies and do not master the possibilities offered by these tools, to imagine their applications in the medical field. This manuscript is indented to be a guide in the use of machine learning in different urology applications, and to demystify the available machine learning and artificial intelligence algorithms. This manuscript reviews some of their applications and potential applications to the medical and urology field.</p><p><strong>Recent findings: </strong>Multiple works are published on the use of machine learning in urology, with performance demonstrated to be noninferior to human experts on multiple occasions. However, the major part of the machine learning publications in urology applications are concentrated on diagnosis and/or prognosis. Advanced machine learning algorithms based on agentic artificial intelligence, able to perform decisions and causality-based treatment optimization, are rarely put to use in urology. The democratization of advanced machine learning technologies in the medical fields can accelerate the adoption of these techniques, and potentially improve the patient care through relevant suggestive decision making.</p><p><strong>Summary: </strong>This work aims to demystify the machine learning tools for medical applications, facilitate decision making and adoption of the correct tools for the correct applications, and places a roadmap for the future of machine learning in the enhancement of patient care in urology.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336416","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}
引用次数: 0
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