European urology focus最新文献

{"title":"Discovery of a Recurrent Frameshift Ashkenazi Jewish Founder Mutation (F722fs) in the PARP Inhibitor-sensitive MMS22L Gene Associated with Higher Risk of Prostate Cancer.","authors":"William B Isaacs, Jun Wei, Marta Gielzak, Qiang Wang, Nathan A Snyder, Siqun Zheng, Guifang Yan, Lucy Lu, Valentina Engelmann, Daniel Rabizadeh, Polina Sysa-Shah, Brandon Cornell, Zhuqing Shi, Huy Tran, Shawn Lupold, Tamara Lotan, Oluwademilade Dairo, Patrick C Walsh, Brian T Helfand, Jim Lu, Jun Luo, Kathleen A Cooney, Jianfeng Xu","doi":"10.1016/j.euf.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Most of the genes for which an association with susceptibility to prostate cancer (PCa) has been established (eg, BRCA2) are involved in DNA repair, with a subset involved in sensitivity to PARP inhibitor (PARPi) therapy. We systematically tested the association with PCa risk for 65 newly reported genes involved in these pathways.</p><p><strong>Methods: </strong>Ancestry-specific association between loss-of-function (LoF) germline variants in these 65 genes and PCa risk was first tested between a cohort of PCa patients from Johns Hopkins University (Hopkins; n = 3,716) and population controls from the Genome Aggregation Database (gnomAD; n = 103,221). Results were confirmed in three additional PCa patient cohorts and the UK Biobank (UKB).</p><p><strong>Key findings and limitations: </strong>Among men of Ashkenazi Jewish ancestry (ASJ), the carrier rate of LoF MMS22L mutations was significantly higher in the Hopkins PCa cohort than in the gnomAD control cohort. The association was confirmed in the UKB. Combined analysis of all cohorts revealed that the carrier rate for F722fs, an ASJ founder mutation, was 1.5% for PCa cases versus 0.31% for controls (odds ratio [OR] 4.9, 95% confidence interval [CI] 2.1-10.6; p = 1.44 × 10^-4, Fisher's test). The proportion of patients with aggressive disease was also significantly higher in the carrier group than in the noncarrier group (83% vs 27%; OR 12.3, 95% CI 2.2-132.5; p = 0.003, Firth test). Another founder mutation in the non-Finnish European population, c.340+1G>A, was significantly associated with PCa risk in the UKB (OR 7.7, 95% CI 2.6-21.0; p =5.10 × 10^-4, Firth test). Somatic DNA analysis and assessment of the response to PARPi therapy are needed.</p><p><strong>Conclusions and clinical implications: </strong>Our results suggest that MMS22L is a novel major gene associated with PCa susceptibility. Its carrier rate and effect size are similar to those for BRCA2. If these results are validated, MMS22L could be used for stratification of PCa risk and aggressiveness.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of the Endoscopic Surgical Approach for Benign Prostatic Obstruction in European Countries.","authors":"Benjamin W Turney, Jean-Nicolas Cornu, Peter Schatteman, Christian Wetterauer, Laura Bruno, Clémentine Demaire, Ryoko Sato, Ilaria Bozzari, Laura Vincenzi, Iván Schwartzmann","doi":"10.1016/j.euf.2025.03.014","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.014","url":null,"abstract":"<p><strong>Background and objective: </strong>The endoscopic surgical approach for treatment of benign prostatic obstruction (BPO) has evolved over time and differs across European countries. We report on variations and trends in Belgium, England, France, Germany, Spain, and Sweden between 2018 and 2023.</p><p><strong>Methods: </strong>Publicly accessible procedure data were used, including procedural volumes, hospital length of stay (LOS), and the proportion of daycase procedures, where available. Procedure codes were categorised to allow cross-country comparison, where appropriate. General linear model and Poisson regression analyses were conducted to assess the statistical significance of differences in volumes, daycase rates, and LOS across procedure categories and countries over time.</p><p><strong>Key findings and limitations: </strong>Data for 1 100 365 endoscopic surgical BPO procedures between 2018 and 2023 were included in the analysis. Surgical volumes, treatment choice, LOS, and daycase rates varied greatly across the six countries. From 2019 to 2023, the relative proportion of transurethral resection of the prostate (TURP) cases declined from 74% to 64.5% in countries with distinct codes for this procedure, while laser treatment and minimally invasive surgical treatment (MIST) cases increased by 8.2% and 1.11%, respectively, on average. LOS was significantly shorter after MIST than after TURP procedures (p < 0.001). The daycase rate was significantly higher for MIST and laser procedures in comparison to TURP (p < 0.001). Procedure code-based data were heterogeneous in terms of their availability, structure, and reporting.</p><p><strong>Conclusions and clinical implications: </strong>European treatment choices for lower urinary tract symptoms secondary to BPO have evolved towards increasingly diversified endoscopic surgical options, including laser and MIST procedures alongside TURP. Data on LOS and daycase activity illustrate that laser and MIST procedures have a low impact on capacity in comparison to TURP. This may help in alleviating hospital capacity constraints, improving resource allocation, and reducing surgical waiting lists.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Stent or Not? A Pragmatic, Multicenter, Combined Randomized and Observational Clinical Trial Evaluating the Impact of Stent Omission Versus Placement After Uncomplicated Ureteroscopy.","authors":"Erik J Sucher, Suprita Krishna, Stephanie Daignault-Newton, Elaina Shoemaker, Sabrina A Clark, Golena Fernandez, Anne Sales, Noelle Carlozzi, William Meurer, Adam Martin-Schwarze, Casey A Dauw, Khurshid R Ghani","doi":"10.1016/j.euf.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.009","url":null,"abstract":"<p><p>Stents are routinely placed after ureteroscopy and can result in patient morbidity. The Stent Omission after Ureteroscopy and Lithotripsy (SOUL) trial will evaluate patient-centered outcomes of stent omission versus placement so that patients and providers can make patient-driven informed decisions.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paclitaxel-coated Balloon Dilation for Urethral Stricture Disease: 5 Years of Clinical Insights and Future Directions for Optilume.","authors":"Maciej Oszczudłowski, Łukasz Białek, Malte W Vetterlein","doi":"10.1016/j.euf.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.013","url":null,"abstract":"<p><p>The Optilume drug-coated balloon is a promising advance for minimally invasive treatment of urethral stricture, with encouraging mid-term results. Further studies are needed to assess its long-term durability, particularly in off-label applications and broader clinical contexts, in comparison to urethroplasty.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Follow-up for Patients with Kidney Stones: European Association of Urology Versus American Urological Association Guidelines.","authors":"Lazaros Tzelves, Patrick Juliebø-Jones, Andreas Skolarikos, Bhaskar K Somani","doi":"10.1016/j.euf.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.015","url":null,"abstract":"<p><p>We compared guidelines on imaging follow-up for urolithiasis from the European Association of Urology and the American Urological Association. The length of imaging follow-up recommended depends on factors that include the type of stone and the size of residual fragments, but recommendations are based on low-level evidence. There is a need to balance any benefits from imaging-follow-up against the potential harms of radiation exposure and costs to the health care system. PATIENT SUMMARY: For patients with kidney stones, follow-up scans may be recommended after treatment to check that the stones have been cleared and are not growing again. Doctors should take into account the need to minimize radiation exposure and costs when deciding the schedule for follow-up scans.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metastasis-directed Therapy in the Management of Urothelial Carcinoma: A Systematic Review and Meta-analysis.","authors":"Marcin Miszczyk, Mateusz Bilski, Tamás Kói, Katarzyna Konat-Bąska, Agata Suleja, Tamás Fazekas, Akihiro Matsukawa, Ichiro Tsuboi, Robert Schulz, Paweł Rajwa, Ekaterina Laukhtina, Melanie R Hassler, Giulia Marvaso, Paul Sargos, Piet Ost, Guillaume Ploussard, Barbara Jereczek-Fossa, Morgan Roupret, Piotr Chłosta, Pierre I Karakiewicz, Marek Babjuk, Jeremy Yuen-Chun Teoh, Marco Moschini, Paolo Gontero, Shahrokh F Shariat","doi":"10.1016/j.euf.2025.03.011","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.011","url":null,"abstract":"<p><strong>Background and objective: </strong>In this prospectively registered meta-analysis (PROSPERO: CRD42024501283), we pooled data on patients treated with metastasis-directed therapies (MDTs) for metastatic urothelial cancer (mUC).</p><p><strong>Methods: </strong>On January 24, 2024, we searched PubMed (MEDLINE), Scopus, and Google Scholar for studies on consolidative MDT in patients with mUC. The search was updated on August 25, 2024. Reports of MDT for brain metastases were excluded. The survival data were synthesised with a distribution-free approach using individual patient data extracted from Kaplan-Meier plots. The risk of bias was assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool.</p><p><strong>Key findings and limitations: </strong>We included 19 retrospective and one prospective study, encompassing a total of 616 patients, published between 2003 and 2024. The median age ranged between 56 and 72 yr. Most patients were treated with surgical metastasectomy (73%), and approximately half received MDT as a first line of treatment for metastases. The pooled 2- and 5-yr overall survival (OS) rates were 64% (95% confidence interval [CI] 58-71%) and 38% (95% CI 33-45%). The median OS was 46.2 mo in patients treated for lung metastases (95% CI 28.7-62.6), 31.2 mo in those treated for lymph node metastases (95% CI 16.1-51.8), and 29 mo in those with mixed-location metastases (95% CI 23.8-38.4). The main limitations were heterogeneity, lack of data from comparative studies, and low quality of the evidence.</p><p><strong>Conclusions and clinical implications: </strong>Many patients with mUC selected for MDT achieve long-term survival, particularly those with lung metastases. Although a causal association cannot be established, MDT emerges as a promising research direction, especially in combination with novel systemic therapies capable of eliciting deep, sustained responses.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Global Perspective on the Adoption of Different Robotic Platforms in Uro-Oncological Surgery.","authors":"Donato Cannoletta, Andrea Gallioli, Elio Mazzone, Josep Maria Gaya Sopena, Angelo Territo, Francesco Di Bello, Marta Casadevall, Laura Mas, Stefano Mancon, Pietro Diana, Joan Palou, Alberto Breda","doi":"10.1016/j.euf.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.016","url":null,"abstract":"<p><p>Robotic platforms have played a crucial role in minimally invasive surgery, especially for uro-oncological procedures. da Vinci robotic platforms have been the most widely adopted for more than two decades and remain the benchmark worldwide. However, access to robotic platforms varies widely across the globe, mainly because of high costs. More recent platforms, such as the Hugo RAS, KangDuo, and others, are lower-cost alternatives. We provide an overview of the distribution of robotic platforms for uro-oncological surgery across countries on the basis of published evidence. da Vinci robotic platforms remain the most widely adopted, with studies reported from 42 countries, followed by the Hugo RAS in 12 countries. Despite advances, many countries lack data, especially in Africa, South America, and parts of Asia, emphasizing the need for multidisciplinary collaboration, training, and policy initiatives. Recently approved novel platforms may contribute to expansion of access to robotic surgery in underserved regions. PATIENT SUMMARY: We reviewed the use of robotic systems for surgery for urological cancers around the globe. We found that the da Vinci system is the most widely used worldwide, but there is a gap in access to these robots in Africa, South America, and parts of Asia. New platforms that are less expensive could lead to wider use of robotic surgery in the future.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do We Need Referral Centers for Benign Prostatic Hyperplasia that Offer Expertise in More Options? Yes, with a SMART (Specialized Medical Assessment for Right Treatment) Approach.","authors":"Silvia Secco, Luca Cindolo","doi":"10.1016/j.euf.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.012","url":null,"abstract":"<p><p>Referral centers for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) play a crucial role in providing personalized and effective solutions for patients. In specialized centers, urologists can effectively select the most appropriate tailored intervention that balances efficacy, morbidity, speed of onset, patient preferences, and disease progression, and can also manage challenging cases. This patient-centered approach should become standard practice for BPH management.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bulking Agents in Male Stress Incontinence.","authors":"Mikolaj Przydacz, Giorgio I Russo, Brian J Linder, Howard B Goldman","doi":"10.1016/j.euf.2025.03.010","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.010","url":null,"abstract":"<p><p>Bulking agents have attracted interest as a minimally invasive treatment for postprostatectomy stress urinary incontinence (PPSUI). The efficacy of bulking agents is modest and success rates vary widely, with short-term improvements reported for some patients but with a decline in durability over time. In comparison to artificial urinary sphincters and male slings, bulking agents are associated with lower continence rates and higher risk of failure. Complication rates depend on the agent used, but most adverse effects are mild. Patient selection is critical, with better outcomes observed for mild to moderate incontinence. Although newer agents show promise, standardized protocols and long-term studies are needed to clarify the efficacy of new bulking agents in PPSUI management. PATIENT SUMMARY: Bulking agents can help temporarily with urine leakage after prostate surgery, but they are less effective than other treatments. Their benefits often fade over time, and more research is needed to assess their long-term usefulness.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suction Ureteral Access Sheaths for Renal Stone Treatment Are Essential for Every Case: Con.","authors":"Thomas Tailly, Matthias Boeykens","doi":"10.1016/j.euf.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.001","url":null,"abstract":"<p><p>A flexible suction ureteral access sheath (FS-UAS) is not essential for every endoscopic renal stone treatment. To date, endoscopic combined intrarenal surgery (ECIRS) is the most efficient approach for treating any renal stone. Rigorous randomized controlled trials comparing retrograde intrarenal surgery with an FS-UAS versus ECIRS should be performed before superiority or even equivalence can be claimed.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}