European urology focus最新文献

{"title":"A Multicenter Randomized Controlled Trial of Ambulatory Versus Inpatient Percutaneous Nephrolithotomy.","authors":"Gregory W Hosier, Darren T Beiko, Heiko Yang, Wilson Sui, David Bayne, Marshall L Stoller, Thomas L Chi","doi":"10.1016/j.euf.2025.09.002","DOIUrl":"https://doi.org/10.1016/j.euf.2025.09.002","url":null,"abstract":"<p><strong>Background and objective: </strong>Ambulatory percutaneous nephrolithotomy (PCNL) has been proposed as a means to speed patient recovery and decrease cost compared with inpatient PCNL. The objective of our study was to perform a high-quality randomized controlled trial of ambulatory versus inpatient PCNL.</p><p><strong>Methods: </strong>A multicenter noninferiority randomized controlled trial of ambulatory versus inpatient PCNL was conducted at Health Sciences Centre Winnipeg, and University of California, San Francisco Medical Center. Patients were randomized prior to surgery, stratified based on American Society of Anesthesiologists (ASA) status, body mass index (BMI), stone size, and study site. The primary outcome was complication rates within 4 wk of surgery.</p><p><strong>Key findings and limitations: </strong>Of 70 patients (35 ambulatory and 35 inpatient), 48% had BMI >30, 41% had ASA 3/4, and 31% had stone size >4 cm. Complication rates were 6% in the ambulatory and 14% in the inpatient group (risk difference -8%, 95% confidence interval [CI] -22% to 5%, p = 0.4). The readmission rate was 6% in the ambulatory versus 3% in the inpatient group (risk difference 3%, 95% CI -7% to 12%, p = 0.6). The stone-free rate was 77% in the ambulatory versus 71% in the inpatient group (risk difference -6%, 95% CI -27% to 15%, p = 0.6). In a multivariable analysis, we did not see evidence of inferiority of ambulatory PCNL compared with inpatient PCNL for complications (odds ratio [OR] 0.49, 95% CI 0.12-1.94, p = 0.3) or residual stone fragments (OR 1.46, 95% CI 0.44-5, p = 0.5). Limitations include a somewhat low sample size.</p><p><strong>Conclusions and clinical implications: </strong>We did not see evidence of inferiority of ambulatory PCNL compared with inpatient PCNL for complication rates, stone-free rates, readmission rates, or quality of life. Our results support the use of ambulatory PCNL at experienced centers.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250690","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":"Observational Health Data Analysis of the Cardiovascular Adverse Events of Systemic Treatment in Patients with Metastatic Hormone-sensitive Prostate Cancer: Big Data Analytics Using the PIONEER Platform.","authors":"Pawel Rajwa, Angelika Borkowetz, Thomas Abbott, Andrea Alberti, Katharina Beyer, Anders Bjartell, James T Brash, Andrew Chilelli, Eleanor Davies, Bertrand De Meulder, Tamas Fazekas, Asieh Golozar, Ayman Hijazy, Andreas Josefsson, Veeru Kasivisvanathan, Raivo Kolde, Daniel Kotik, Michael S Leapman, Marcin Miszczyk, Rossella Nicoletti, Peter Prinsen, Sebastiaan Remmers, Maria J Ribal, Juan Gómez Rivas, Lara Rodriguez-Sanchez, Monique J Roobol, Emma Smith, Robert Snijder, Carl Steinbeisser, Hein V Stroomberg, Giorgio Gandaglia, Philip Cornford, Susan Evans-Axelsson, James N'Dow, Peter-Paul M Willemse","doi":"10.1016/j.euf.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.005","url":null,"abstract":"<p><strong>Background and objective: </strong>Although cardiovascular toxicity from modern systemic treatments in metastatic hormone-sensitive prostate cancer (mHSPC) remains a concern, real-world data are limited. We aimed to characterise patients treated for mHSPC across multiple large cohorts and estimate cardiovascular adverse event (AE) risks.</p><p><strong>Methods: </strong>Leveraging PIONEER's Big Data platform, with databases standardised using the Observational Medical Outcomes Partnership model, we defined cohorts and calculated the incidence rates of AEs per 1000 person-years. The time to first event was assessed via a Kaplan-Meier analysis, and the mean cumulative function (MCF) was estimated for recurrent events. Analyses were stratified by therapy and database.</p><p><strong>Key findings and limitations: </strong>We included 90 087 mHSPC patients from five databases, treated with androgen deprivation therapy (ADT) + androgen receptor pathway inhibitor (ARPI) + docetaxel (DOC) (n = 3743), ADT + ARPI (n = 13 588), ADT + DOC (n = 16 287), or ADT alone (n = 56 469). The distribution of age (63.5-73.7 yr) and comorbidities varied between databases (eg, for hypertension 22-79%). Diabetes was reported in up to 33%, heart failure in 17%, obesity in 25%, and kidney impairment in 26% of men. The highest incidence rates of AEs were as follows: 115 cases (ADT) for acute cardiac events, 403 (ADT + ARPI) for cerebral events, 214 (ADT + ARPI) for thromboembolism, 34 (ADT) for chronic heart failure, and 143 (ADT + ARPI + DOC) for hypertension. The 3-yr acute cardiac event-free survival rate ranged from 79% to 97%, and the 3-yr MCF for acute cardiac events was up to 0.33. Limitations include the retrospective nature and a lack of AE grading.</p><p><strong>Conclusions and clinical implications: </strong>Our study highlights important heterogeneity in real-world, observational mHSPC data. The included patients demonstrated a substantial comorbidity burden, often exceeding that reported in clinical trials, alongside a high rate of cardiovascular AEs.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228309","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":"Re: Tamás Fazekas, Marcin Miszczyk, Alexander Giesen, et al. Androgen Receptor Pathway Inhibitor Monotherapy in Prostate Cancer: Safety, Oncologic Outcomes, and Quality of Life-A Systematic Review and Meta-analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.05.006.","authors":"I-Hung Shao, Chun-Te Wu, Yu-Hsiang Lin","doi":"10.1016/j.euf.2025.08.013","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.013","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198799","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":"PUrE Randomised Controlled Trial 2: Clinical and Cost Effectiveness of Flexible Ureterorenoscopy and Percutaneous Nephrolithotomy for Lower-pole Stones of 10-25 mm.","authors":"Daron Smith, Oliver Wiseman, Kathryn Starr, Lorna Aucott, Rodolfo Hernández, Ruth Thomas, Steven MacLennan, Charles Terry Clark, Graeme MacLennan, Dawn McRae, Victoria Bell, Seonaidh Cotton, Zara Gall, Ben Turney, Sam McClinton","doi":"10.1016/j.euf.2025.08.010","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.010","url":null,"abstract":"<p><strong>Background and objective: </strong>The European Association of Urology guidelines for lower-pole stones (LPS) recommend percutaneous nephrolithotomy (PCNL) for stones >20 mm, flexible ureterorenoscopy (FURS) or PCNL for stones of 10-20 mm if there are unfavourable factors for extracorporeal shockwave lithotripsy (ESWL), or any of these options for stones of 10-20 mm if there are no unfavourable factors for ESWL. PUrE RCT 2 was a pragmatic multicentre, open-label, superiority, randomised controlled trial comparing FURS versus PCNL in terms of quality of life, clinical effectiveness, and cost effectiveness for patients with LPS of 10-25 mm.</p><p><strong>Methods: </strong>A total of 159 adults with LPS of 10-25 mm were randomised, 73 to FURS and 86 to PCNL. The primary outcome was health status area under the curve (AUC) measured weekly using the EQ-5D-5L questionnaire up to 12 wk after intervention. The primary economic outcome was the incremental cost per quality-adjusted life year (QALY) gained at 12 mo from randomisation.</p><p><strong>Key finding and limitations: </strong>Mean health status AUC slightly favoured PCNL (difference -0.07, 95% confidence interval [CI] -0.11 to -0.02) when adjusted for baseline status. The complete stone clearance rate was higher with PCNL (71%) than with FURS (48%). PCNL was less costly (adjusted mean difference £733, 95% CI -£508 to £1973) and resulted in greater QALYs (adjusted mean difference -0.001, 95% CI -0.044 to 0.042). At a threshold value of £20 000 per QALY, PCNL has an 87% chance of being cost-effective.</p><p><strong>Conclusions and clinical implications: </strong>Results from PUrE RCT 2 show that PCNL resulted in marginally better health status and a higher stone-free rate and was more cost-effective than FURS among patients with LPS of 10-25 mm. These outcomes are important for patient counselling and joint decision-making on LPS treatment.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174395","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":"Cancer-specific Mortality After Radical Nephrectomy and Thrombectomy for Renal Cell Carcinoma with Tumor Thrombus According to Histological Subtypes.","authors":"Michele Nicolazzini, Mattia Longoni, Fabian Falkenbach, Andrea Marmiroli, Quynh Chi Le, Calogero Catanzaro, Federico Polverino, Jordan A Goyal, Alberto Briganti, Markus Graefen, Gennaro Musi, Felix K H Chun, Riccardo Schiavina, Nicola Longo, Fred Saad, Shahrokh F Shariat, Carlotta Palumbo, Alessandro Volpe, Pierre I Karakiewicz","doi":"10.1016/j.euf.2025.08.007","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.007","url":null,"abstract":"<p><strong>Background and objective: </strong>We tested the effect of histological subtypes on cancer-specific mortality (CSM) after radical nephrectomy (RN) with thrombectomy for nonmetastatic renal cell carcinoma with tumor thrombus (RCC-TT) within the Surveillance, Epidemiology and End Results database (2010-2021).</p><p><strong>Methods: </strong>We used propensity score matching (PSM), multivariable competing-risk regression (CRR) analyses, and cumulative incidence functions to test differences in CSM between papillary RCC (pRCC) and clear-cell RCC (ccRCC), and between chromophobe RCC (chRCC) and ccRCC.</p><p><strong>Key findings and limitations: </strong>Of 5516 patients with nonmetastatic RCC-TT, 180 (3.3%), 186 (3.4%), and 5150 (93%) harbored pRCC, chRCC, and ccRCC, respectively. TT was limited to the renal vein in 135 (75%), 168 (91%), and 4457 (87%) patients with pRCC, chRCC, and ccRCC, respectively. After 1:3 PSM, 180 (100%) pRCC cases were compared with 540 (11%) ccRCC cases. The 5-yr CSM rate was 43% in pRCC versus 26% in ccRCC. Multivariable CRR revealed that pRCC independently predicted higher CSM relative to ccRCC (hazard ratio [HR] 1.81, 95% confidence interval [CI] 1.31-2.50; p < 0.001). After 1:3 PSM, 186 (100%) chRCC cases were compared with 558 (11%) ccRCC cases. The 5-yr CSM rate was 14% in chRCC versus 19% in ccRCC. Multivariable CRR revealed no significant difference in CSM between chRCC and ccRCC (HR 0.62, 95% CI 0.37-1.03; p = 0.07). Limitations include the retrospective nature of the study and a lack of data on disease progression and subsequent treatment.</p><p><strong>Conclusions and clinical implications: </strong>For patients with RCC-TT treated with RN with thrombectomy, pRCC independently predicted a 1.8-fold higher CSM rate in comparison to ccRCC, with no significant difference in CSM rates between chRCC and ccRCC. Adjuvant therapy should be considered for patients with pRCC or chRCC in the TT setting.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148395","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":"Managing Genital Herpes: A Mini-review for Urologists from the European Association of Urology Guidelines Panel for Urological Infections.","authors":"Guglielmo Mantica, Jennifer Kranz, Tommaso Cai, Suzanne Geerlings, Bela Köves, Sören Schubert, Adrian Pilatz, José Medina-Polo, Laila Schneidewind, Rajan Veeratterapillay, Florian M E Wagenlehner, Wout Devlies, Kathrin Bausch, Lorenz Leitner, Fabian Stangl, Hala Ali, Gernot Bonkat","doi":"10.1016/j.euf.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.euf.2025.09.001","url":null,"abstract":"<p><p>Genital herpes (GH) is a prevalent, lifelong, sexually transmitted infection caused by herpes simplex virus types 1 and 2. Although traditionally managed by dermatologists and infectious disease specialists, GH is increasingly relevant to urologists owing to its clinical complexity and psychosocial impact. This mini-review by the European Association of Urology Guidelines Panel for Urological Infections summarizes updated evidence on GH epidemiology, diagnosis, treatment, and prevention strategies. Diagnosis remains challenging because of atypical presentations; polymerase chain reaction is the preferred diagnostic test. Management mainly relies on nucleoside analogs, with new therapies under investigation. Suppressive treatment reduces recurrences and transmission. Routine screening of asymptomatic individuals is not recommended. Effective counseling and partner notification are critical components of care. PATIENT SUMMARY: Patients with genital herpes should receive clear information on the nature of the infection, the diagnostic process, and treatment options and preventive strategies. Urologists must play a key role in managing symptoms, reducing the risk of transmission, and supporting patients through education and counseling.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130423","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":"Single-dose Versus 3-day Antimicrobial Prophylaxis in Transurethral Resection or Photoselective Vaporization of the Prostate: A Multicenter, Randomized, Placebo Controlled Trial (CITrUS Trial).","authors":"Kathrin Bausch, Benjamin Speich, Deborah R Vogt, Lars G Hemkens, Maeve Dreher, Maciej Kwiatkowski, Svetozar Subotic, Peter Ardelt, Piet Bossard, Thomas Hermanns, Nicole Bruni, Stephen Wyler, Lukas Prause, Sarah-Charlotte Merz, Christian Engesser, Jan Roth, Andreas F Widmer, Hans-Helge Seifert","doi":"10.1016/j.euf.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.009","url":null,"abstract":"<p><strong>Background and objective: </strong>Guidelines recommend single-dose antimicrobial prophylaxis (AMP) for transurethral resection (TURP) and photoselective vaporization (PVP) of the prostate. As guideline adherence is low and 3-d AMP is given frequently, we aimed to assess the noninferiority of a single dose compared with 3-d AMP by comparing the incidence of urinary tract infections (UTIs) within 30 d.</p><p><strong>Methods: </strong>A double-blind, multicenter, randomized, noninferiority trial was conducted comparing single-dose with 3-d AMP in patients assigned to TURP and PVP, assuming a 9% event rate for a clinical diagnosis of a UTI with a 4.4% noninferiority margin.</p><p><strong>Key findings and limitations: </strong>From anticipated 1574 patients, 728 were recruited and 621 randomized patients were analyzed fully. The study was preliminary stopped due to delayed recruitment and was analyzed exploratively. Following single-dose AMP, 11.0% of patients (95% confidence interval [CI] 7.9%, 15.0%; 33/300) had a clinical diagnosis of UTIs, compared with 8.5% (95% CI 5.8%, 12.1%; 26/307) receiving 3-d AMP (between-group difference 2.5% [95% CI -2.2%, 7.5%]). The rates of UTIs supported by bacteriuria were lower without any difference between groups (single-dose AMP: 3.3% [95% CI 1.8%, 6.0%]; 3-d AMP: 3.3% [95% CI 1.8%, 5.9%]; between-group difference 0.08% [95% CI -2.97%, 3.16%]). Adverse events were rare.</p><p><strong>Conclusions and clinical implications: </strong>In this randomized trial of transurethral prostate surgery patients, 11.0% of those on single-dose AMP and 8.5% on 3-d AMP were diagnosed with UTIs. The smaller than planned sample size precludes a definite interpretation favoring either group. Diagnoses of UTIs based on symptoms and bacteriuria reduced the overall rates and group differences.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052632","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":"Re: Vineet Gauhar, Olivier Traxer, Daniele Castellani, et al. Could Use of a Flexible and Navigable Suction Ureteral Access Sheath Be a Potential Game-changer in Retrograde Intrarenal Surgery? Outcomes at 30 Days from a Large, Prospective, Multicenter, Real-world Study by the European Association of Urology Urolithiasis Section. Eur Urol Focus 2024;10:975-82.","authors":"Yun Deng, Changhong Xu, Li Yang","doi":"10.1016/j.euf.2025.07.021","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.021","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039494","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":"Reply to Hao Wang and Li Yang's Letter to the Editor re: Mariana Silva-Ferreira, João A. Carvalho, Sofia Salta, et al. Diagnostic Test Accuracy of Urinary DNA Methylation-based Biomarkers for Bladder Cancer: Considerations for Further Research. Eur Urol Focus 2024;10:922-34.","authors":"Mariana Silva-Ferreira, Luísa Lopes-Conceição, Sara Monteiro-Reis, Rui Henrique, Carmen Jerónimo","doi":"10.1016/j.euf.2025.08.002","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.002","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947998","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: Neoadjuvant Chemotherapy for Upper Tract Urothelial Cancer.","authors":"Sean A Fletcher, Nirmish Singla, Jean Hoffman-Censits","doi":"10.1016/j.euf.2025.07.014","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.014","url":null,"abstract":"<p><p>In this Clinical Consultation Guide, we highlight prospective studies supporting the use of preoperative cisplatin-based chemotherapy in patients with upper tract urothelial carcinoma for whom extirpative surgery is planned.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947983","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}