European urology focus最新文献

{"title":"Prostate-specific Antigen Response as a Prognostic Factor for Overall Survival in Patients with Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors: A Systematic Review and Meta-analysis.","authors":"Marcin Miszczyk, Tamás Fazekas, Paweł Rajwa, Akihiro Matsukawa, Ichiro Tsuboi, Michael S Leapman, Gero Kramer, Maha Hussain, Axel Merseburger, Alberto Briganti, Anthony V D'Amico, Silke Gillessen, Fred Saad, Shahrokh F Shariat","doi":"10.1016/j.euf.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.019","url":null,"abstract":"<p><strong>Background and objective: </strong>For patients with advanced prostate cancer (PC) treated with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI), the decline in prostate-specific antigen (PSA) is a potential biomarker for treatment response. We synthesised data regarding the association of the PSA response with overall survival (OS).</p><p><strong>Methods: </strong>The MEDLINE, Embase, Web of Science, and Google Scholar databases were searched up to November 2024 to identify studies evaluating the association between the PSA response and OS among patients treated with ADT + ARPI. Hazard ratios (HRs) were pooled in random-effects meta-analyses.</p><p><strong>Key findings and limitations: </strong>We identified 14 studies comprising a total of 8883 patients. Among four studies in metastatic hormone-sensitive PC (n = 2197), achievement of an undetectable PSA level was associated with better OS (HR 0.33, 95% confidence interval [CI] 0.23-0.49). In two studies in nonmetastatic castration-resistant PC (n = 1507), a PSA decline to <0.2 ng/ml (HR 0.28, 95% CI 0.21-0.36), a PSA reduction of ≥90% (HR 0.39, 95% CI 0.28-0.52), and a PSA reduction of ≥50% (HR 0.34, 95% CI 0.16-0.69) were associated with better OS. Among four studies in metastatic castration-resistant PC (n = 3728), PSA reductions of ≥90% (HR 0.22, 95% CI 0.14-0.34) and ≥50% (HR 0.29, 95% CI 0.20-0.41) were associated with better OS. The main limitations include heterogeneity in study designs and use of ADT before baseline PSA measurement in mHSPC studies.</p><p><strong>Conclusions and clinical implications: </strong>The PSA response following ADT + ARPI therapy is significantly associated with OS across all metastatic and castration-resistant PC states and could serve as a clinically useful early signal of efficacy. It remains to be proven whether the PSA response is a surrogate for OS or should guide changes in clinical care.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086039","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":"Gleason Grade Group 3 Represents a Spectrum of Disease: Results from a Large Institutional Cohort.","authors":"Kevin Shee, Janet E Cowan, Chien-Kuang Cornelia Ding, Lufan Wang, William Pace, Nancy Greenland, Jeffry P Simko, Samuel L Washington, Katsuto Shinohara, Hao G Nguyen, Matthew R Cooperberg, Peter R Carroll","doi":"10.1016/j.euf.2025.04.027","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.027","url":null,"abstract":"<p><strong>Background and objective: </strong>A biopsy diagnosis of Gleason grade group (GG) 3 prostate cancer (PC) automatically classifies patients as having at least unfavorable intermediate-risk disease warranting definitive treatment. We hypothesized that GG3 PCs are not equally unfavorable.</p><p><strong>Methods: </strong>The Urologic Outcomes Database at University of California-San Francisco was queried for men with localized, nonmetastatic PC diagnosed after 2000 who underwent radical prostatectomy (RP). The primary outcome was recurrence, defined as either biochemical failure (two prostate-specific antigen results ≥0.2 ng/ml) or salvage treatment. Multivariable Cox proportional-hazards regression models were used to calculate associations with the risk of recurrence, adjusted for clinicodemographic and postoperative factors.</p><p><strong>Key findings and limitations: </strong>We included 4934 men who underwent RP in the analysis, of whom 862 (17%) were diagnosed with GG3 PC on biopsy. Cancer of the Prostate Risk Assessment postsurgery (CAPRA-S) scores overall increased over time, but remained broadly distributed. Multivariable analysis controlled for postoperative factors with CAPRA-S revealed that favorable biopsy Gleason histology (not expansile cribriform or intraductal carcinoma) was the strongest factor associated with lower risk of recurrence after RP (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.41-0.91), independent of the percentage of pattern 4. A higher percentage of positive cores (PPC) was also significantly associated with the risk of recurrence (HR per 10% increment: 1.06, 95% CI 1.01-1.11). Limitations include the retrospective nature of the single-institution study and the homogeneous study population.</p><p><strong>Conclusions and clinical implications: </strong>Patients with GG3 PC on diagnostic biopsy have heterogeneous risk. Unfavorable biopsy histology and higher PPC were significantly associated with the risk of recurrence after RP after controlling for CAPRA-S scores. Not all GG3 cancers are equally unfavorable, and differential management may be warranted.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076881","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":"Contemporary Practice in Adrenal Surgery: A Review of Multiport versus Single-port and Transperitoneal versus Retroperitoneal Approaches.","authors":"Mohammed Hegazy, Saif Toubasey, Francesco Del Giudice, Ben Challacombe","doi":"10.1016/j.euf.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.004","url":null,"abstract":"<p><p>Robotic adrenalectomy has emerged as the preferred approach for adrenal gland surgery because of its greater precision, better ergonomics, good safety profile, and minimally invasive nature. There is ongoing debate over the optimal surgical approach, specifically regarding multiport versus single-port platforms, and transperitoneal versus retroperitoneal access. Multiport robotic adrenalectomy remains the standard because of its familiarity and wider surgical exposure, whereas single-port surgery offers the advantage of better cosmesis and lower incision-related morbidity despite a more challenging learning curve. The transperitoneal approach provides familiar and superior anatomic visibility and working space, while the retroperitoneal approach avoids intra-abdominal dissection, reduces postoperative ileus, and may be preferable in selected patients. This review summarises the advantages and limitations of each technique to inform surgical decision-making. PATIENT SUMMARY: This review compares ways of performing keyhole surgery on the adrenal gland. Keyhole surgery using multiple small incisions has been more common because of the ease of use and familiarity, while keyhole surgery using a single incision has better cosmetic results but is more difficult. Accessing the adrenal gland through the abdomen (transperitoneal access) provides better visibility, whereas access by avoiding the abdomen (retroperitoneal access) allows faster patient recovery after surgery.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076877","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":"Ultrasound for the Diagnosis of Testicular Torsion: A Systematic Review and Meta-analysis of Diagnostic Accuracy.","authors":"Cameron E Alexander, Hannah Warren, Alexander Light, Ridhi Agarwal, Aqua Asif, Bing Jie Chow, Keiran Clement, Vinson Chan, Eleanor Zimmermann, Sinan Khadhouri, Pieter Jan Eyskens, Taimur T Shah, Arjun Nathan, Kevin Byrnes, Nikita Bhatt, Nick Mani, Cathy Yuhong Yuan, Paul S Sidhu, Yemisi Takwoingi, Veeru Kasivisvanathan","doi":"10.1016/j.euf.2025.04.026","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.026","url":null,"abstract":"<p><strong>Background and objective: </strong>Uncertainty regarding the diagnostic accuracy of ultrasound for testicular torsion (TT) and a lack of high-level evidence to inform international guidelines have led to significant global variation in its use. The objective of this study was to assess the diagnostic accuracy of ultrasound for TT.</p><p><strong>Methods: </strong>This systematic review was undertaken in accordance with the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A comprehensive electronic search strategy was applied up to January 4, 2024. Colour Doppler sonography (CDS) was the primary index test, with surgical scrotal exploration or clinical follow-up as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the risk of bias and applicability. Meta-analyses were performed using bivariate models.</p><p><strong>Key findings and limitations: </strong>Sixty-three studies met the inclusion criteria; 54 (85.7%) assessed CDS, and the others assessed spectral doppler sonography (n = 6), contrast enhanced ultrasound (n = 1), or an alternative combination of ultrasound technologies (n = 2). The summary sensitivity (95% confidence interval [CI]) and specificity (95% CI) of CDS for the diagnosis of TT were 95.3% (91.4-97.5) and 98.3% (96.2-99.3), respectively (42 studies, 4422 participants). Patient selection (related to the risk of bias and applicability concern) was identified as the domain of the greatest methodological concern on QUADAS-2 assessment.</p><p><strong>Conclusions and clinical implications: </strong>CDS has high diagnostic accuracy for TT. The ideal patient pathway for suspected TT should integrate timely access to ultrasound alongside clinical assessment, with careful patient counselling.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076884","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":"Radioguided Surgery for Prostate Cancer.","authors":"Leonardo Quarta, Armando Stabile, Arturo Chiti, Francesco Montorsi, Alberto Briganti, Giorgio Gandaglia","doi":"10.1016/j.euf.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.003","url":null,"abstract":"<p><p>Prostate-specific membrane antigen radioguided surgery (PSMA-RGS) is an emerging technique that provides real-time intraoperative guidance for identification of lymph node metastases (LNMs) in patients with prostate cancer (PC). PSMA-RGS uses PSMA ligands labeled with radionuclides that emit γ or β particles and has shown promise in enhancing the accuracy of surgery. Introduced for salvage lymph node dissection in patients experiencing biochemical recurrence, PSMA-RGS has demonstrated high specificity and positive predictive value, although sensitivity remains limited for micrometastatic disease. Recent studies on PSMA-RGS during extended pelvic lymph node dissection in the primary setting showed that it is safe and feasible, with superior accuracy in comparison to preoperative PSMA positron emission tomography. Despite its advantages, PSMA-RGS has limited sensitivity for micrometastatic LNMs because of spatial resolution for the probe. PSMA-RGS represents a promising tool for optimizing surgical management in PC. However, future studies with long-term follow-up are needed to refine detection strategies and evaluate its oncological impact. PATIENT SUMMARY: Radioguided surgery using radioactive compounds that bind to a protein called PSMA (prostate-specific membrane antigen) is a safe procedure that may help surgeons in identifying metastasis in lymph nodes during robot-assisted surgery for prostate cancer. While this technique has potential to enhance treatment outcomes, further studies are necessary to confirm its long-term benefits.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076883","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":"Disrupted Circadian Rhythm as a Mediator of Autonomic Dysregulation and Overactive Bladder in Men with Benign Prostatic Hyperplasia.","authors":"Yu-Hsiang Lin, Yu-Chen Chen, Jau-Yuan Chen","doi":"10.1016/j.euf.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.001","url":null,"abstract":"<p><p>Overactive bladder (OAB) and nocturnal polyuria (NP) significantly impact quality of life, particularly in aging men with benign prostatic hyperplasia (BPH). While often managed as localized lower urinary tract issues, emerging evidence suggests a complex interplay involving systemic factors. This mini-review explores the hypothesis that BPH-induced sleep disruption, primarily via nocturia, can trigger a cascade involving central circadian dysregulation, subsequent autonomic nervous system (ANS) imbalance, and hormonal shifts (including antidiuretic hormone and testosterone) that ultimately contribute to OAB symptoms and NP. Conditions such as obstructive sleep apnea can exacerbate this cycle. Manifestations of ANS dysfunction, such as altered heart rate variability and nondipping blood-pressure patterns, are increasingly recognized in these patients. Current pharmacological treatments for OAB such as anticholinergic agents and β3-adrenoceptor agonists, may primarily address the downstream consequences of ANS dysregulation. This intricate network highlights the potential need for integrated management strategies targeting sleep, circadian health, and ANS balance alongside traditional urological approaches. PATIENT SUMMARY: Older men often experience frequent nighttime urination (nocturia) associated with an enlarged prostate gland. This review discusses how the resulting poor sleep can disrupt the body's internal clock and control of the nervous system. This disruption can worsen bladder problems such as overactive bladder and increase nighttime urine production, and can potentially affect heart rate patterns and blood pressure. This suggests that managing sleep and the body's rhythms might be important alongside standard bladder treatments for these patients.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076879","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":"Clinical Consultation Guide: When To Perform Urodynamics in Female Stress Urinary Incontinence.","authors":"Thomas R F van Steenbergen, Laetitia M O de Kort","doi":"10.1016/j.euf.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.008","url":null,"abstract":"<p><p>Most women with stress urinary incontinence have complicating factors. This guide explores when urodynamics can aid in diagnosis and treatment.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994482","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":"Current Role of Robotic Inguinal Lymphadenectomy in Penile Cancer.","authors":"Savio Domenico Pandolfo, Arianna Biasatti, Arie Parnham, Riccardo Autorino, Oscar R Brouwer","doi":"10.1016/j.euf.2025.04.032","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.032","url":null,"abstract":"<p><p>Lymph node (LN) metastases are the most significant prognostic factor in penile cancer (PeC), so timely detection and adequate treatment of LN metastases is crucial. While open inguinal LN dissection (ILND) remains the standard for most cases, its morbidity has spurred interest in robot-assisted videoendoscopic ILND (RA-VEIL). We summarize current international guidelines and evidence on the current role of RA-VEIL in LN management for PeC. RA-VEIL is feasible and has been associated with fewer wound complications and an equivalent nodal yield in comparison to open ILND. However, lymphatic complications appear to remain the same. Therefore, for nodal staging in patients with cN0 PeC, sentinel node biopsy is preferred over RA-VEIL. In node-positive patients, more studies, especially prospective studies, are needed to confirm the long-term oncological safety of RA-VEIL before it can be incorporated in guidelines as a recommended treatment option. PATIENT SUMMARY: For patients with penile cancer, spread to the lymph nodes is a crucial factor in determining probable survival. We summarize the current role of a robot-assisted telescopic technique under video guidance for lymph node management. This technique is feasible and may lead to fewer wound infections, but lymphatic complications seem to be the same as with open surgery. More studies are needed to confirm the long-term cancer control outcomes of this technique.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989258","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":"Selecting Minimally Invasive Surgical Treatments for Benign Prostatic Hyperplasia: A Clinical Consultation Guide.","authors":"Peter Ka-Fung Chiu, Brian W H Siu, Cosimo De Nunzio","doi":"10.1016/j.euf.2025.04.025","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.025","url":null,"abstract":"<p><p>Optimal patient selection on the basis of prostate size, presence of a median lobe, and patient preferences is key to success for various minimally invasive surgical treatments for benign prostatic hyperplasia (BPH), including Rezūm, UroLift, a temporary implantable nitinol device, prostate artery embolization, and Optilume BPH balloon dilatation.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963905","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":"Management of Stress Urinary Incontinence in Patients with Underactive Bladder.","authors":"Salvador Arlandis","doi":"10.1016/j.euf.2025.04.030","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.030","url":null,"abstract":"<p><p>The coexistence of detrusor underactivity (DUA) and female stress urinary incontinence presents a challenge for urologists. The various DUA definitions used in the literature and the predominantly retrospective nature of most studies contribute to a low level of evidence regarding optimal management for these patients. However, efficacy outcomes appear to be quite similar to those observed for patients without DUA, albeit with a slight increase in voiding symptoms. The role of adjustable slings, bulking agents, and artificial urinary sphincters remains unclear, so identification of the most appropriate solution via a shared decision-making process with the patient is essential. PATIENT SUMMARY: For women who have stress urinary incontinence, management can be difficult for those who also have an underactive bladder. This mini review discusses the treatment options available and their advantages and disadvantages. Shared decision-making between the doctor and patient is crucial in choosing the option that best suits an individual patient's needs.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963901","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}