Diana Babaevskaya, Andrey Morozov, Eddie Fridman, Larisa Tsoy, Shahrokh F Shariat, Yossef Molchanov, Maxim Yakimov, Eva Compérat, Thomas R W Herrmann, Dmitry Enikeev
{"title":"En bloc resection of large bladder tumor: is it feasible and reasonable?","authors":"Diana Babaevskaya, Andrey Morozov, Eddie Fridman, Larisa Tsoy, Shahrokh F Shariat, Yossef Molchanov, Maxim Yakimov, Eva Compérat, Thomas R W Herrmann, Dmitry Enikeev","doi":"10.1097/MOU.0000000000001265","DOIUrl":"10.1097/MOU.0000000000001265","url":null,"abstract":"<p><strong>Purpose of review: </strong>Transurethral resection of bladder tumor (TURBT) remains the basis of bladder tumor diagnosis and an effective means of treating nonmuscle invasive bladder cancer (NMIBC). There are several limitations to this procedure: TURBT may cause free floating of malignant cells in the bladder and as a result re-implantation and early recurrence. Also, it does not allow the pathologist to define the correct spatial orientation of the specimen. The development of en bloc resection of bladder tumor (ERBT) has helped overcome the abovementioned key disadvantages of TURBT. However, many urologists doubt whether this approach is feasible for treating larger tumors.</p><p><strong>Recent findings: </strong>In this review, it is shown that ERBT of large bladder tumor (>3 cm) is in fact a feasible and well tolerated method. Although there is a lack of comparative data proving its advantages over TURBT, en bloc in large tumor seems to result in better local cancer control (due to higher prevalence of detrusor specimen, lower need for re-TURBT), lower rate of relapse outside the resection area (due to lower risk of tumor cells circulation), and higher quality of pathology specimen.</p><p><strong>Summary: </strong>Despite the skepticism of some surgeons, potential difficulties caused by larger tumor size may be overcome easily, and most agree that tumor size should not limit the implementation of the method in their daily practice.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"385-389"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001822","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}
Megha Garg, Philip Joseph, Hans Johnson, Joseph Vayalil Lawrence, Bhaskar Somani, Bhavan Prasad Rai, Joe Philip
{"title":"Obesity and BMI score as risk factors for urolithiasis: a systematic review over 30 years.","authors":"Megha Garg, Philip Joseph, Hans Johnson, Joseph Vayalil Lawrence, Bhaskar Somani, Bhavan Prasad Rai, Joe Philip","doi":"10.1097/MOU.0000000000001298","DOIUrl":"10.1097/MOU.0000000000001298","url":null,"abstract":"<p><strong>Purpose of review: </strong>To examine association between high BMI, obesity, and kidney stone disease (KSD). For this, systematic review of empirical studies was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) guidelines. Cochrane Library, EMBASE, MEDLINE, CINAHL, AMED, Emcare, Clinicaltrials.gov, and WHO ICTRP were searched for English language population-based studies published from inception to October 2024, including adults aged at least 18 years reporting on high BMI, obesity and overweight, with incidence of KSD.</p><p><strong>Recent findings: </strong>The search identified 943 records, of which 15 relevant articles with 97 645 participants and 17 158 cases in total were enrolled in the narrative synthesis. A high heterogeneity and imbalance were observed among baseline distribution of cohorts in most studies. Thirteen studies provided comparative data on stone occurrence in obese and nonobese participants, and on per-patient analysis, three studies demonstrated a lower risk (RR < 1; 95% CI: 0.78-1.03), four studies a higher risk (RR>1; 95% CI: 0.77-2.32), and six studies depicted similar risk (RR = 1; 95% CI: 0.94-1.06) of stone occurrence between the two cohorts.</p><p><strong>Summary: </strong>Evidence in this study suggests an association between high BMI, being overweight, obesity, and increased risk of developing kidney stone disease. In the context of optimizing treatment, KSD should be considered a metabolic disease, with treatment to include dietary regimes, exercise intervention alongside pharmacotherapy to help reduce renal stone disease recurrence risk, alongside managing associated chronic diseases such as hypertension, type 2 diabetes mellitus, and coronary artery disease.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"338-346"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969355","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":"Salvage treatment of local recurrence following radical and partial nephrectomy.","authors":"Davide Perri, Carlotta Palumbo, Alessandro Volpe","doi":"10.1097/MOU.0000000000001286","DOIUrl":"10.1097/MOU.0000000000001286","url":null,"abstract":"<p><strong>Purpose of review: </strong>Standardized definition of local recurrence after radical or partial nephrectomy is still lacking. Due to its rarity, data on natural history, oncological outcomes and prognostic factors are scarce and specific treatment recommendations cannot be made.</p><p><strong>Recent findings: </strong>Surgery is still the preferred option to treat a local recurrence of renal cell carcinoma, with favorable survival outcomes. However, nonsurgical options like thermal ablation techniques may represent a valid alternative mainly in patients where a nephron-sparing treatment is imperative. Systemic therapy seems to have a limited role in this setting.</p><p><strong>Summary: </strong>According to available data, surgical excision of local recurrence should be attempted whenever feasible. Alternatively, thermal ablation represents a reliable and repeatable option after partial nephrectomy, with low complication rate and good oncologic outcomes. However, the evidence comes mainly from limited, heterogeneous case series. Further high-quality studies are needed to properly define the most appropriate for each individual patient.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"481-488"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972328","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}
David Ventura, Benjamin Noto, Nadir Rodriguez Jauregui, Wolfgang Roll, Kambiz Rahbar
{"title":"Toxicities of radioligand and radioisotope therapy in prostate cancer: a systematic review and meta-analysis.","authors":"David Ventura, Benjamin Noto, Nadir Rodriguez Jauregui, Wolfgang Roll, Kambiz Rahbar","doi":"10.1097/MOU.0000000000001300","DOIUrl":"10.1097/MOU.0000000000001300","url":null,"abstract":"<p><strong>Purpose of review: </strong>This systematic review and meta-analysis investigate the toxicities of radioligand and radioisotope therapies - [ 177 Lu]lutetium-prostate-specific membrane antigen (PSMA) (Lu-PSMA), [ 225 Ac]actinium-PSMA (Ac-PSMA), and [ 223 Ra]radium-dichloride (223-Radium) - in metastatic prostate cancer. While previous studies have explored this topic, most failed to differentiate between treatment-emergent adverse events (TEAEs) and preexisting conditions, leading to inflated toxicity rates. By focusing exclusively on TEAEs, this study provides a more accurate and clinically relevant assessment.</p><p><strong>Recent findings: </strong>This meta-analysis of 65 studies including 8706 patients identified haematotoxicities as the most frequent TEAEs across all therapies, affecting 10-20% of patients. Fatigue is a common nonhematologic adverse event in all treatments. Low grade xerostomia is specifically associated with Lu-PSMA and Ac-PSMA therapies, occurring in 30% and 84% of patients, respectively, while 223-Radium is uniquely linked to an increased fracture risk. Severe toxicities (Common Terminology Criteria for Adverse Events ≥ 3) are rare across all therapies. By clearly distinguishing TEAEs from baseline conditions, this study addresses a gap in the existing literature.</p><p><strong>Summary: </strong>Severe TEAEs are uncommon across Lu-PSMA, Ac-PSMA, and 223-Radium therapies. Still, monitoring and managing specific toxicities to optimize the safety and tolerability of these therapies in clinical practice is mandatory, especially concerning xerostomia in Ac-PSMA therapy.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"472-480"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977015","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}
János Szalontai, Tibor Szarvas, Marcin Miszczyk, Péter Nyirády, Shahrokh F Shariat, Tamás Fazekas
{"title":"Toxicities of PARP inhibitors in genitourinary cancers.","authors":"János Szalontai, Tibor Szarvas, Marcin Miszczyk, Péter Nyirády, Shahrokh F Shariat, Tamás Fazekas","doi":"10.1097/MOU.0000000000001297","DOIUrl":"10.1097/MOU.0000000000001297","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recent advancements in the understanding of the genetic background of genitourinary cancers allowed for a successful introduction of targeted antitumor agents to prostate cancer (PCa) treatment. Inhibitors of the poly ADP-ribose polymerase enzyme (PARPi) transformed the treatment landscape of metastatic prostate cancer, and being increasingly studied in earlier disease stages. However, they are associated with nonnegligible toxicity, therefore, we aimed to summarize their side-effect profile in patients with PCa.</p><p><strong>Recent findings: </strong>Hematologic toxicities, particularly anemia, thrombocytopenia, and neutropenia are among the most common and serious adverse events associated with PARPi, highlighting the need for regular blood count monitoring. Nonhematologic side effects, including fatigue, nausea, vomiting, diarrhea, and constipation, are common, and can be mitigated with supportive interventions like dietary modifications, antiemetics, or stool management techniques. Special attention should be given to patients with therapy-resistant or persistent cytopenia, in whom bone marrow biopsy should be considered, as it can indicate myelodysplastic syndrome and acute myeloid leukemia.</p><p><strong>Summary: </strong>PARP inhibitors represent a major advancement in the management of metastatic prostate cancer, offering a significant survival benefit in applicable cases. However, patients need to be carefully selected and informed, to allow for optimal balancing between the benefits and nonneglectable risks of severe toxicities. Better understanding of PARPi toxicity profile can improve personalized decision-making and enhance treatment compliance, through raising patients' awareness about the possible side effects of PARPi.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"467-471"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981254","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}
Paolo Zaurito, Armando Stabile, Francesco Montorsi, Alberto Briganti, Giorgio Gandaglia
{"title":"The prognostic role of prostate MRI in prostate cancer patients.","authors":"Paolo Zaurito, Armando Stabile, Francesco Montorsi, Alberto Briganti, Giorgio Gandaglia","doi":"10.1097/MOU.0000000000001288","DOIUrl":"10.1097/MOU.0000000000001288","url":null,"abstract":"<p><strong>Purpose of review: </strong>Multiparametric MRI (mpMRI) has been included in the diagnostic pathway of prostate cancer (PCa). However, the role of this imaging modality in predicting clinical outcomes after diagnosis has been poorly addressed so far. This review aims to summarize the most relevant updates on the prognostic role of mpMRI.</p><p><strong>Recent findings: </strong>Baseline mpMRI features help to predict adverse pathology at radical prostatectomy (RP) and grade reclassification during active surveillance. Parameters derived at prostate mpMRI such as PI-RADS score 4-5, the maximum diameter of the index lesion and the presence of extracapsular invasion/seminal vesicle invasion are among the strongest predictors of biochemical recurrence (BCR) for men treated with RP. mpMRI-based predictive models can achieve similar accuracy for BCR prediction when compared with validated models that relied on final pathology. Moreover, the use of mpMRI findings to predict disease recurrence after radiotherapy or focal therapy seems to optimize patient's risk stratification after treatment, ruling out disease recurrence.</p><p><strong>Summary: </strong>Clinicians should account for prostate mpMRI findings when predicting clinical outcomes in patients diagnosed with PCa.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"418-425"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990166","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}
Alfonso Romero Crespo, Daniel Carrasco Gomez, Nestor Manuel Sanchez Martinez, Carlos Bautista Vidal, Lydia Flores Sirvent, Rodrigo España Navarro, Emilio Garcia Galisteo
{"title":"Prostate-specific antigen doubling time in prostate cancer: a review of calculation methods and clinical implications.","authors":"Alfonso Romero Crespo, Daniel Carrasco Gomez, Nestor Manuel Sanchez Martinez, Carlos Bautista Vidal, Lydia Flores Sirvent, Rodrigo España Navarro, Emilio Garcia Galisteo","doi":"10.1097/MOU.0000000000001303","DOIUrl":"10.1097/MOU.0000000000001303","url":null,"abstract":"<p><strong>Purpose of review: </strong>Prostate-specific antigen doubling time (PSADT) is a key prognostic marker in prostate cancer, especially in cases of biochemical recurrence. It guides risk stratification and therapeutic decisions, but its calculation varies significantly across institutions. This review addresses the clinical relevance of PSADT and the need for standardized methods.</p><p><strong>Recent findings: </strong>Multiple models exist for PSADT calculation, including logarithmic regression, linear models, and nadir subtraction. Logarithmic regression best reflects PSA's exponential growth but requires at least three PSA values over time. Measurement variability - due to assay differences or sampling intervals - can affect PSADT estimates by 15-40%, impacting treatment decisions. Correction tools like the Memorial Sloan Kettering Cancer Center's Excel calculator have reduced variability by up to 30-40%, improving reliability.</p><p><strong>Summary: </strong>PSADT remains a valuable tool in prostate cancer management, particularly for guiding salvage therapies in biochemical recurrence. However, its accuracy depends on the calculation method and PSA measurement quality. Integrating validated tools like the MSKCC calculator and adopting standardized approaches can enhance clinical decision-making. This review underscores the need for improved harmonization of PSADT methodology across guidelines and clinical settings.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"447-452"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076674","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}
Magdalena Koett, Felix Melchior, Nastasiia Artamonova, Jasmin Bektic, Isabel Heidegger
{"title":"Redefining prostate cancer care: innovations and future directions in active surveillance.","authors":"Magdalena Koett, Felix Melchior, Nastasiia Artamonova, Jasmin Bektic, Isabel Heidegger","doi":"10.1097/MOU.0000000000001268","DOIUrl":"10.1097/MOU.0000000000001268","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides a critical analysis of recent advancements in active surveillance (AS), emphasizing updates from major international guidelines and their implications for clinical practice.</p><p><strong>Recent findings: </strong>Recent revisions to international guidelines have broadened the eligibility criteria for AS to include selected patients with ISUP grade group 2 prostate cancer. This adjustment acknowledges that certain intermediate-risk cancers may be appropriate for AS, reflecting a heightened focus on achieving a balance between oncologic control and maintaining quality of life by minimizing the risk of overtreatment.</p><p><strong>Summary: </strong>This review explores key innovations in AS for prostate cancer, including multi parametric magnetic resonance imaging (mpMRI), genomic biomarkers, and risk calculators, which enhance patient selection and monitoring. While promising, their routine use remains debated due to guideline inconsistencies, cost, and accessibility. Special focus is given to biomarkers for identifying ISUP grade group 2 cancers suitable for AS. Additionally, the potential of artificial intelligence to improve diagnostic accuracy and risk stratification is examined. By integrating these advancements, this review provides a critical perspective on optimizing AS for more personalized and effective prostate cancer management.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"439-446"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440170","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":"Current clinical evidence in intrarenal temperature, pressure and suction during retrograde intrarenal surgery: a review of literature.","authors":"Theodoros Tokas, Vineet Gauhar, Steffi Kar Kei Yuen, Bhaskar Kumar Somani","doi":"10.1097/MOU.0000000000001270","DOIUrl":"10.1097/MOU.0000000000001270","url":null,"abstract":"<p><strong>Purpose of review: </strong>Experimental evidence suggests that intrarenal temperatures (IRTs) and pressures (IRPs) during retrograde intrarenal surgery (RIRS) with laser lithotripsy are clinically significant. Suction devices aim to facilitate RIRS and improve procedure outcomes. We present an overview of new clinical studies regarding IRT, IRP, and suction developments.</p><p><strong>Recent findings: </strong>High laser power, low irrigation, and restricted working space were directly correlated with increased IRTs. Increased irrigation flow rate and ureteral access sheath (UAS) maintained well tolerated IRTs. Baseline IRPs ranged from 16 to 17 mmHg. Intraoperative IRP monitoring maintained values below 22 mmHg. Hand-assisted pumps often increase IRPs above the safety threshold. Prolonged IRP increments were correlated to postoperative infections. Suction devices decreased operative time to less than 60 min and improved stone-free rates (SFRs) at 1 day to more than 80 and at 30 days to more than 90%.</p><p><strong>Summary: </strong>Despite the limited clinical evidence, IRTs during RIRS correlate directly with laser power and reversely correlate with irrigation flow rate and UAS use. Intraoperative IRP monitoring prevents hazardous increments. Manual pump irrigation causes extremely high IRPs. There is a possible relation between prolonged IRP increments and infectious complication development. Using suction UAS or flexible and navigable sheaths (FANS) improves operative times and SFRs, while more studies regarding direct in-scope suction (DISS) efficiency and safety are needed.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"390-398"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457187","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}
Steffi Kar Kei Yuen, Bhaskar Somani, Vineet Gauhar
{"title":"Measuring, monitoring and reporting intrarenal pressure: a practical guide to endourologists from section of EAU Endourology.","authors":"Steffi Kar Kei Yuen, Bhaskar Somani, Vineet Gauhar","doi":"10.1097/MOU.0000000000001284","DOIUrl":"10.1097/MOU.0000000000001284","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"399-411"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729182","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}